i/t SUMMARIES OF STATE LAWS RELATING TO THE INSANE PREPARED ORIGINALLY BY JOHN KOREN REVISED BY S. W. HAMILTON, M. D. ROY HABER, LL. B., A. M. THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC. 50 Union Square, New York 1917 iblication No. 10 SUMMARIES OF STATE LAWS RELATING TO THE INSANE SUMMARIES OF STATE LAWS RELATING TO THE INSANE PREPARED ORIGINALLY BY JOHN KOREN REVISED BY S. W. HAMILTON, M. D. ROY HABER, LL. B., A. M. THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC. 50 Union Square, New York 1917 Copyrighted 1918 Persons may quote from these summaries freely, provided appropriate credit be given. The National Committee for Mental Hygiene 50 UNION SQUARE, NEW YORK CITY Founded 1909 Incorporated 1916 President DR. LEWELLYS F. BARKER CHARLES W. ELIOT Vice-Presidents DR. WALTER B. JAMES DR. WILLIAM H. WELCH Treasurer OTTO T. BANNARD DR. WILLIAM L. RUSSELL, Chairman, Executive Committee RUSSELL H. CHITTENDEN, Chairman, Finance Committee DR. WALTER E. FERNALD, Chairman, Committee on Mental Deficiency DR. CHARLES L. DANA, Chairman, War Work Committee Executive Officers DR. THOMAS W. SALMON, Medical Director DR. FRANKWOOD E. WILLIAMS, Associate Medical Director CLIFFORD W. BEERS,' Seer etary MRS. MILO M. ACKER, Hornell, N. Y. JANE ADDAMS, Chicago EDWIN A. ALDERMAN, Charlottesville, Va. MRS. A. A. ANDERSON, Greenwich, Conn. DR. PEAHCE BAILEY, New York DR. CHAS. P. BANCROFT, Concord, N. H. OTTO T. BANNARD, New York DR. LEWELLYS F. BARKER, Baltimore DR. ALBERT M. BARRETT, Ann Arbor, Mich. DR. FRANK BILLINGS, Chicago SURG. GEN. RUPERT BLUE, Washington DR. GEORGE BLUMER, New Haven DR. G. ALDER BLUMER, Providence WILLIAM H. BURNHAM, Worcester DR. C. MACFIE CAMPBELL, Baltimore RUSSELL H. CHITTENDEN, New Haven DR. L. PIERCE CLARK, New York DR. WILLIAM B. COLBY, New York DR. OWEN COPP, Philadelphia DR. CHARLES L. DANA, New York C. B. DAVENPORT, Cold Spring Harbor STEPHEN P. DUGGAN, New York CHARLES W. ELIOT, Cambridge DR. CHAS. P. EMERSON, Indianapolis ELIZABETH E. FAHRELL, New York W. H. P. FAUNCE, Providence KATHERINE S. FELTON, San Francisco DR. WALTER E. FERNALD, Boston JOHN H. FINLEY, Albany IRVING FISHER, New Haven MATTHEW C. FLEMING, New York HOMER FOLKS, New York DR. CHARLES H. FRAZIER, Philadelphia JAMES, CARDINAL GIBBONS, Baltimore ARTHUR T. HADLEY, New Haven DR. WILLIAM HEALEY, Boston DR. ARTHUR P. HERRING, Baltimore HENRY L. HIGGINSON, Boston DR. AUGUST HOCH, Montecito, Cal. WM. J. HOGGSON, Greenwich, Conn. DR. WALTER B. JAMES, New York MRS. WILLIAM JAMES, Cambridge HARRY PRATT JUDSON, Chicago DR. CHARLES G. KERLEY, New York DR. GEORGE H. KIRBY, New York FRANKLIN B. KIHKBRIDE, New York DR. GEORGE M. KLINE, Boston JOHN KOREN, Boston JULIA C. LATHROP, Washington ADOLPH LEWISOHN, New York SAMUEL McCuNE LINDSAY, New York DR. CHARLES S. LITTLE, Thiells, N. Y. GEORGE P. MCLEAN, Simsbury, Conn. V. EVERIT MACY, Scarborough, N. Y. MARCUS M. MARKS, New York MRS. WILLIAM S. MONROE, Chicago DR. J. MONTGOMERY MOSHER, Albany DR. FRANK P. NORBURY, Jacksonville, 111. CYRUS NORTHROP, Minneapolis WM. CHURCH OSBORN, New York DR. STEWART PATON, Princeton DR. FREDERICK PETERSON, New York HENRY PHIPPS, New York GIFFORD PINCHOT, Washington FLORENCE M. RHETT, New York DR. ROBERT L. RICHARDS, Talmage, Cal. MRS. CHARLES C. RUMSEY, New York DR. WM. L. RUSSELL, White Plains, N. Y. JACOB GOULD SCHURMAN, Ithaca DR. ELMER E. SOUTHARD, Boston DR. M. ALLEN STARR, New York DR. HENRY R. STEDMAN, Brookline, Mass. ANSON PHELPS STOKES, New Haven DR. CHAS. F. STOKES, New York DR. FREDERICK TILNEY, New York VICTOR MORRIS TYLER, New Haven MRS. WM. K. VANDEHBILT, New York HENRY VAN DYKE, Princeton DR. HENRY P. WALCOTT, Cambridge LILLIAN D. WALD, New York DR. WILLIAM H. WELCH, Baltimore BENJAMIN IDE WHEELER, Berkeley, Cal. DR. WM. A. WHITE, Washington DR. HENRY SMITH WILLIAMS, New York ROBERT A. WOODS, Boston ROBERT M. YERKES, Minneapolis CHIEF PURPOSES: T mental defects in all the the standards of care an every State an affiliated Society for Mental Hygiene. ork for the conservation of mental health; to promote the study of mental disorders and forms and relations; to obtain and disseminate reliable data concerning them; to help raise nd treatment; to help co-ordinate existing agencies, Federal, State and local, and to organize in Inquiries regarding the work of the Committee, including its quarterly magazine "MENTAL HYGIENB", and requests for publications issued or distributed by the organization should be addressed to The National Committee for Mental Hygiene, 50 Union Square, New York City. 2061647 CONTENTS PAGE Officers, Members, and Chief Purposes of The National Committee for Mental Hygiene iii Introduction vii-x Preface to Revision of 1917 xi Alabama 1 Alaska 5 Arizona 7 Arkansas 11 California 16 Colorado 25 Connecticut 31 Delaware 38 District of Columbia 42 Florida 47 Georgia 51 Idaho 55 Illinois 58 Indiana 65 Iowa 73 Kansas 79 Kentucky 86 Louisiana 90 Maine 94 Maryland 101 Massachusetts 106 Michigan 117 Minnesota 124 Mississippi 131 Missouri 134 Montana 138 Nebraska 142 Nevada 148 New Hampshire 151 New Jersey 156 New Mexico 162 New York t 164 North Carolina 180 North Dakota 186 Ohio 192 Oklahoma 199 Oregon 205 Pennsylvania 208 Rhode Island 216 South Carolina 222 South Dakota 226 Tennessee 231 Texas 236 Utah 239 Vermont 243 Virginia 247 Washington 253 West Virginia 257 Wisconsin 262 Wyoming 270 v INTRODUCTION The National Committee for Mental Hygiene is pledged among other things "to work for the conservation of mental health and to help raise the standards of care and treatment for those suffer- ing from mental disorder." As a contribution toward these pur- poses, it presents this volume, summarizing the laws relating to the commitment and care of the insane in the United States. From their very nature mental disorders have always been made the subject of public supervision and therefore of legislation. In their inception, the laws relating to the insane merely intended to safeguard the public against a class of unfortunates who were con- sidered dangerous to others. With the modern conception of the mentally disordered as sick persons who are amenable to treatment, and whose ailments are more or less preventable, has arisen a new body of legislation which seeks to realize higher ideals. These ideals must be reached primarily by aid of wise laws, for not only are most of the mentally sick charges thrown upon public sup- port, but mental infirmity involves a peculiar separation from soci- ety of uncertain duration, and this separation brings questions of personal liberty, property rights, guardianship, supervision, etc., all of which are matters for legal regulation. To deal more adequately with the problem of insanity is, therefore, first of all a question of adjusting our laws to meet the many perplexing sides it presents. It is a common observation that states with highly developed systems for the care and treatment of the insane also have the best and most complete laws on the subject. On the other hand, where standards of care are comparatively low and the provisions for the mentally ill inadequate, one is as certain to find the laws rudimen- tary and insufficient. In short, the insanity laws reflect with much fidelity the status of public care given the insane. In view of the great importance of the legislation under consid- eration, it deserves far more public attention than is given it. Each one of the forty-eight states of the Union has its body of laws in regard to the care and commitment of the insane. Although there are not forty-eight different systems of laws, since some states have been content to copy general features from other states, there is a bewildering diversity of legislation, showing all stages of develop- ment or lack of development in the care of the insane. The insanity laws as they stand to-day impress one, beyond the fact that so many of them are wholly inadequate, as the product of hasty, un- systematic tinkering. Very few constitute a well-rounded whole or bear marks of far-sighted study. Indeed, most of the laws are built upon ancient structures to which additions have been made as exigencies arose. Perhaps the most characteristic thing about the insanity laws is that they are constantly being mended and amended. For the greater part the laws present a chaotic mass, which it is exceedingly difficult to survey. To reduce it to comparable dimen- sions has been the task. The National Committee for Mental Hygiene believes that, in presenting these summaries, it is perform- ing a service which conforms to its programme. By setting forth systematically what the laws of the different states prescribe in regard to the insane and the various provisions made for them, a comparative study of legislation is made possible, which should prove useful alike to the legislator, to those specifically charged with the supervision and care of the insane, and to all persons inter- ested. If better systems and higher standards and, above all, gen- eral uniformity in legislation are to be attained, the first step is an exposition in convenient form of existing laws. This and little more the present publication would supply. The summaries cover the existing laws in each state, including Alaska and the District of Columbia. The legal provisions made for the insane outside of Continental United States have not been considered. The summaries are based upon a first-hand exam- ination of the present codes and statutes of the respective states, ending with first half of the year 1917. In order to present the summaries in a convenient form for com- parisons between states in regard to the most important provisions of the laws, it was necessary to adopt a uniform scheme. There- fore the extracts of the laws of the different states are given under specified headings regardless of the fact that the codes and statutes follow a different order of presentation. The matter contained in the summaries has been gathered under the following general heads: 1. ADMINISTRATION AND SUPERVISION. a. General. b. Institutional. 2. CARE. a. In state institutions. b. In local institutions. 3. COMMITMENT. a. Persons committed. b. Legal procedure in commitment. c. Voluntary admission. IX d. Appeal from commitment. e. Cost of commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL. 5. TRANSFER OF PATIENTS. 6. PAROLE AND DISCHARGE OF PATIENTS. 7. COST OF MAINTENANCE. 8. CRIMINAL INSANE. In a useful summary of state systems of care of the insane belongs, self-evidently, a statement not only of institutional man- agement, but of general administration and supervision. There- fore, the composition, general powers and duties of state boards of insanity, state boards of charities and corrections and other super- visory bodies are given in some detail. It also seemed desirable to outline briefly what the laws prescribe in regard to institutional management. The portions of the law contained under divisions 3, 6 and 8 have been summarized with due regard to details as they are of special importance. The original text has been followed as closely as pos- sible. Briefer statements could have been obtained by greater avoidance of the language of the statutes, but not without a definite loss and perhaps the bewilderment of persons familiar with the laws of their own state. A great mass of mere verbiage has been excluded. The prescriptions concerning forms of records, interroga- tories, etc., were wholly omitted as lacking in general interest and making for inordinate length. A few codes make much of prescriptions that in most instances are left to the discretion of boards of managers of hospitals, for instance, in regard to postal facilities for patients and the like. Matters of this kind were usually omitted, likewise the often very lengthy enactments concerning bookkeeping, financial statements, forms of reports, etc. The unequal emphasis placed by the codes upon the obviously important and obviously unimportant is necessarily reflected in the summaries; and, from the point of view of some persons, things may have been omitted which they regard as significant. This was unavoidable as the views of individuals in this respect differ. It is believed, however, that the essentials of the laws have been faithfully stated. Of course in many instances the laws of certain states contain enactments of which counterparts are not found in others. This accounts for the blanks under some headings. In other instances, apparent omissions mean that the matters in question have not been made the object of general legislation, but are left to the regu- lation of the boards of trustees of the hospitals or other officials. Although the criminal insane are relatively few, the legal pro- visions in regard to them have been stated in some detail because the importance of the subject is more and more being recognized. The numbers in the margin make it possible at once to refer to the original code or statute from which the section in question was taken. For the greater part the different paragraphs have not been furnished with sub-heads. The general headings make it clear what they deal with, so that the reader will have little diffi- culty in orienting himself. J. K. PREFACE TO REVISION OF 1917 As many states have made changes in their statutes, a new edi- tion of this work seems desirable in order that the latest informa- tion may be available. Only minor changes have been made in the plan of the work. A directory of state institutions for the insane has been included, so that the possessor of the book may have that information at hand without consulting some other document. A new section has been added relative to voluntary admission. This is a subject of increasing importance, many states now recog- nizing the desirability of allowing patients to seek help in this way. Attention is invited to the growing tendency in legislation to lessen the rigors of commitment and to emphasize the medical rather than the legal aspects of insanity in providing relief for those afflicted with mental diseases. S. W. H. R. H. ALABAMA Authorities : Code of Alabama, 1907 Amendments of 1915 i. ADMINISTRATION AND SUPERVISION a. General. There is in Alabama no central administrative or supervisory board of charitable institutions. There is, however, trustees! a corporation under the name of "The Alabama Insane Hospitals" C 8 d 3 e <;. that manages and controls the two state hospitals for the insane and f^; any other allied state institutions, such as those for the care and 842 ' treatment of epileptics, feebleminded, inebriates, and the like, that may at any time be confided to it by law. The corporation, or board of trustees, consists of seven members, each member holding office for seven years. The governor is ex-officio the presiding officer of the board. Four of the trustees must be licensed physicians; three must reside near the Bryce Hospital; two, convenient to the Mount Vernon Hospital. They' receive no salary but are allowed their traveling expenses while on official business. Vacancies are filled by the board itself, subject to confirmation of the senate. The board reviews and investigates the affairs of the hospitals, 8 44- and must annually prepare and transmit to the governor a full report of the wants, interests, conditions, receipts, and expenditures of the hospitals for the preceding fiscal year. It prepares a book of rules for the government and instruction of the employees of the hospitals. 8 4S- For the immediate government and control of the hospitals, the board of trustees elects a superintendent, who is the executive officer Superintend- of the board, for a term of not less than eight years, and determines en 8 4 7. his salary. The superintendent may be removed from office by the board of trustees for just cause. The superintendent, subject to the approval of the trustees, appoints all the assistant physicians, 8 4- stewards, managers, supervisors, nurses, and other employees of the hospitals. He has power to remove any of them from the employ of the hospitals at his discretion. b. Institutional. There are no local boards of trustees. Each hospital is under the direct supervision of an assistant superin- tendent, who is responsible to the general superintendent. (See a. General.) 2. CARE a. In state institutions. The Bryce Hospital, Tuscaloosa; established 1860; 1,800 beds. (For whites exclusively.) The Mount Vernon Hospital, Mount Vernon; established 1902; 1,000 beds. (For negroes exclusively.) The criminal insane are received at both hospitals. b. In local institutions. The court of county commissioners has the duty of supporting the poor of their county, including the insane who can not be maintained at the state hospitals. The poorhouses in which the insane may be kept are under the man- agement of the court of county commissioners. 3. COMMITMENT a. Persons committed. A person is defined as insane and there- 854. fore suitable for commitment to a state hospital if he has been found by a proper court deficient or defective mentally so that for his own or others' welfare his removal is required for restraint, care, and treatment. 855. The superintendent is authorized, when the hospitals are crowded to accept only those patients that are offensively troublesome or dangerous to their own welfare and to decline those that are harm- less or helpless. He may arrange with the probate judges to ex- change harmless patients in the hospital for those that are dangerous. pjHcation. b. Legal procedure in commitment. Application for the ad- mission of a person to the insane hospital must be made to the judge of probate in the county in which the alleged insane person resides. If the judge of probate after due investigation finds the case a suit- able one, he must make application to the superintendent for the admission of the patient, accompanying it with full and explicit answers to prescribed interrogatories concerning the patient. When informed by the superintendent that the person can be received as a vestigation. pat j ent) t h e judge of probate must call witnesses, at least one of whom must be a physician, and fully investigate the facts of the case, either with or without a jury, and either with or without the presence in the court of the person in question. If the judge or the jury believe the person is sufficiently defective mentally to be sent to a hospital for insane persons, the judge must make two copies of the certificate of the mental disqualifications, without which no person may be admitted, one of which is to be filed in his office, and the other to be sent with the patient to the hospital. c. Voluntary admission. 3 ALABAMA d. Appeal from commitment. At any time after an inquisition* J|ti n g of for guardianship, the person ascertained to be of unsound mind, by 3sa. himself, or by next friend, may apply in writing to the court of pro- bate for a revocation of the proceedings, the application to be accompanied by the certificate of two physicians, or of two other competent persons, stating that after examination of such person, they' believe him to be of sound mind. Not more than ten days 4353 ' thereafter, a hearing must be held. If the allegations of the application are denied, the court must J^y tri fi. summon a jury to try the case; and the same proceedings must be had as upon the original inquisition. If there is no contest, and the court is satisfied of the truth of the application, he must revoke the proceedings on the inquisition and the guardianship, and declare the ward restored to the custody and management of his estate. If the verdict of the jury negatives the facts cited in the applica- 4353. tion, a judgment of dismissal, at the cost of the applicant, or next friend, must be entered. Any person who is restrained of liberty under any pretense what-Habeas^ corpus, soever, may prosecute a writ of habeas corpus. e. Cost of commitment. The cost of commitment and of trans- portation to the hospital must be paid by the county treasury in the case of an indigent person. 4. CONVEYING PATIENTS TO THE HOSPITAL The judge of probate must require a relative, friend or officer, as he 860. sees fit, to convey the patient to the hospital. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent may grant friends or relatives permission to 1 *"^ 8 ' remove from the hospital on trial at their expense any harmless patient whom he thinks it will benefit. Such a patient may be returned by friends or those in charge, but at the expiration of six months, if the patient has not been returned, he shall be regarded as discharged and readmission can not be obtained without the same legal process as if the patient never had been admitted. When a patient has been restored to a normal and comparatively safe and good mental condition sufficiently long to warrant the opinion by the superintendent that he ought to be returned to his home, or set at large again, the superintendent must inform the friends or relatives of the patient's recovery, and if they do not furnish the money to pay the traveling expenses, he must notify the judge of probate of the county, and the commissioners of the county ALABAMA Indigents. 861. 863. then pay out of the county treasury the necessary expenses for the return of the patient to his home. 7. COST OF MAINTENANCE The judge of probate must examine the financial standing of the person adjudged insane, and if he has not sufficient means to pay for his support at the hospital, it must be so stated in the certificate of won-indigents. admission and the expense is then borne by the state. When a patient or his parents or guardians possess means, or his relatives or friends care to provide for his support, the judge of probate must contract with responsible parties for the payment quarterly in ad- vance of the amount chargeable for such patients, and cause a bond with sufficient surety to be made. The judge of probate from each county must from time to time at his own instance, if his attention is drawn to it by the superintendent or other person, investigate the financial standing of any indigent patient in the hospital from his county; and if he finds him able to pay for his support, he must, under penalty of having the patient returned at the county's ex- pense to his home, contract with responsible parties for the payment in question. The judge of probate can transfer a paying patient who has become indigent to the indigent class. 8. CRIMINAL INSANE No criminal or person indicted for crime, who has been declared insane, may be sent to an insane hospital until the sheriff or other officer having legal custody of said patient has forwarded to the superintendent an application and a description of the case, accord- ing to the form prescribed for judges of probate, together with a certified copy of the order of the court. When any person sentenced to imprisonment in the penitentiary or to hard labor becomes insane, the physician in attendance must report the fact to the governor, who must appoint three suitable persons, one of them a physician, to examine the convict, and if they declare him insane and fit to be sent to the hospital, application must be directed for his admission. When any insane convict is brought to the hospital, instructions must always be given to whom his recovery is to be reported. Upon recovery of such a patient the proper officer must be notified and immediately remove him. A death sentence may be suspended during the determination of the sanity of a convict. 86 S . Commitment. 872. Insane convicts. 871. 873. 7X79- ALASKA Authority: Compiled Laws of Alaska, 1913 i. ADMINISTRATION AND SUPERVISION a. General. There is no general administrative board of chari- table institutions. The legally adjudged insane of the territory are under the general supervision of the secretary of the depart- ment of the interior at Washington, D. C. b. Institutional. The private sanitarium to which the insane and mentally defective of the territory are committed is visited and inspected at regular intervals and occasionally is subjected to special investigation by agents of the United States department of the interior. The detention hospitals at Fairbanks and Nome are under the control of the United States marshal of the district in which they are situated. 2. CARE a. In territorial institutions. The territory has no hospital f or <^?|f ct> the insane. The secretary of the interior receives bids for the care La ^ and custody of those adjudged insane and contracts at his discretion for their care with some hospital or sanitarium west of the Rocky Mountains. For several years Morningside Hospital, a private institution near Portland, Oregon, has cared for these patients. b. In local institutions. At Fairbanks and Nome are detention JfspuS? hospitals for the care of the insane until they are transported to the 83a< States. 3. COMMITMENT a. Persons committed. Any legally adjudged insane person in 83I< the territory may be given care at the hospital with which the government has its contract. b. Legal procedure in commitment. Complaint in writing may c< ^P laint - be made by any adult person that an insane person is at large. This complaint is made to a commissioner appointed by the judge Commissioner - of the district court to have probate jurisdiction. The commissioner has the alleged insane person brought before him and tries the issue before a jury of six male adults. Some person must be appointed to Jury trlal> represent the alleged insane person and if a physician or surgeon is in the vicinity and can be procured he examines the patient and testifies. If the jury unanimously finds that the person charged is ALASKA 6 insane, the commissioner, if he approves the verdict, orders the insane person committed to the hospital for the insane. c. Voluntary admission. Habeas corpus, d. Appeal from commitment. Every person imprisoned or re- 13981 strained except by virtue of a judgment or execution is entitled to a writ of habeas corpus. e. Cost of commitment. All costs approved by the district judge are paid by the clerk of the court. 4. CONVEYING PATIENTS TO THE HOSPITAL The United States marshal of the district in which the proceed- ings are held conveys the patient to the hospital. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Parole. While the contract of the department of the interior with the hospital does not specifically provide for the release of persons on parole, it is the uniform practice of the department to parole Alaskan patients in the custody of their friends or relatives when their condition warrants, requiring the supplying of a satisfactory bond for the safe care and custody of the patient. Discharge. The patient is detained "until duly discharged by law," the government furnishing transportation and expenses back to Alaska for any patient discharged as cured. 7. COST OF MAINTENANCE The cost of maintaining persons in the hospital and in the deten- tion hospitals is met by appropriations made by Congress. 8. CRIMINAL INSANE ARIZONA Authorities: Revised Statutes of Arizona, 1913 Laws of Arizona, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The commission of state institutions is composed ^ t of three electors appointed by the governor, with the consent of l senate, and holding office at 'his pleasure. Not more than two ch - 8 - members may be of the same political party. Each commissioner receives an annual salary of $3,000 and necessary traveling ex- penses, and must devote his entire time to the duties of his office and may not engage in any other occupation. The commission renders an annual report to the governor. The commission has oversight and general control of all chari- table, reformatory, penal, and other institutions established and maintained by the state. It employs a secretary at an annual salary of $2,400 and such other persons as may be needed. It prescribes uniform systems of records and accounts, and must keep in its office a complete record of all transactions at each of the Institutions under its jurisdiction. The entire commission must visit and inspect each institution at least once in six months and a member must visit and inspect each institution at least once in thirty days. The commission apppoints and discharges the chief officers of each of the state institutions. Except where appointed by the commis- sion, the superintendent or chief executive officer of each state institution appoints and discharges all of his assistants, the number being determined by the commission. All salaries are fixed by the commission unless otherwise provided by law. The commission purchases all supplies for the state institutions, has charge of the erection of new buildings and of all repairs and improvements. No member shall receive gift from an individual or firm with which the commission does business, nor shall a member or employee of the commission attempt to influence the political views of other members or employees or contribute anything for political purposes. The commission has the power to bring suit, to summon and ex- amine witnesses and to compel the production and examination of books and papers; and any person failing to obey the orders of the commission in this connection shall be dealt with by the Superior Court as for contempt of court. ARIZONA 8 Application. Revised statutes. "99- Examination. superintend. ft Institutional. There is no local board of trustees. The superintendent of the state hospital is appointed by the commis- sion. He may, under the control of the commission, appoint all assistants and employees. 2. CARE. a. In state institutions. Arizona' State Hospital, Phoenix; established 1886; 500 beds. b. In local institutions. 3. COMMITMENT a. Persons committed. All insane persons Bre entitled to ad- mission to the state hospital. Pay patients may be received under rates established by the commission of state institutions. b. Legal procedure in commitment. The superior judge of any county, upon a sworn application that a person by reason of insanity is dangerous if at large, must cause the person to be brought before him for examination and summon two or more witnesses acquainted with the accused at the time of the alleged insanity. He must also call in one or more graduates of medicine and reputable practitioners to be present at the hearing, and after a personal ex- amination of the accused to make a written statement under oath in regard to his mental condition, whether it is unsafe to let him go at large and whether his insanity is likely to prove permanent or only temporary. If the proofs satisfy the judge that the person is insane and can not safely be allowed at large, he must direct the confinement of such person in the hospital for the insane until, sufficiently restored to reason. c. Voluntary admission. ibeas corpus, . Appeal from commitment. Every person unlawfully com- mitted or restrained of his liberty may prosecute a writ of habeas corpus to inquire into the cause of the restraint, by petition, signed either by the party for whose relief it is intended or by some person in his behalf. Such writ may be granted by the supreme court or any district court. i3oo. e . Cost of commitment. The cost of the commitment of an insane person must be borne by him if he has sufficient estate. If he is indigent, the cost is chargeable to the county from which he was sent. 4. CONVEYING PATIENTS TO THE HOSPITAL The board of supervisors of each county must cause insane persons to be conveyed to the hospital for the insane and provide meanwhile for their safe-keeping and care. The board of supervisors- of counties are authorized, when necessary, to contract with the 9 ARIZONA lowest responsible bidder for the transportation of insane persons of their counties to the hospital. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent has authority" to release on parole patients f^erfntendem. not of a suicidal or homicidal tendency and who may be in a state 4469 ' of convalescence, upon application of their relatives or friends, who are required to give bond guaranteeing their proper care and main- tenance and their return to the hospital if necessary, and to keep the superintendent informed each month of the mental and physical condition of the patients. The commission of state institutions may by order discharge any theboard! by patient who is not insane nor a proper case for treatment, under such 446j> * regulations and rules as it may prescribe. Any poor and indigent patient discharged by the superintendent or upon the order of the commission because he is an idiot, an imbecile, not insane, or By* 11 ?. superintendent. because he is not a proper case for treatment within the meaning of the law, must be returned to the care of the county from which he was committed. Every cured and discharged indigent patient must be furnished by the superintendent with $5 in cash, a suit of clothes and a half-fare ticket on any railroad or railway within the state. Any person who has been declared insane, or the guardian, or J| titi ^ or io any relative within the third degree, or any friend, may petition the of restoration, probate judge of the county in which the person was declared in- sane, to have the fact of his restoration judicially determined. The judge must appoint a day for the hearing, and, if the petitioner re- quest it, order the investigation before a jury, notice of the trial having been given to the guardian of the petitioner, to his or her husband or wife, and to his or her father or mother, if living in the country. The guardian or relative of the petitioner, and, in the discretion of the judge, any other person, may contest the right of the petitioner to the relief demanded. If the petitioner is found of sound mind and capable of taking care of himself and his property, his restoration to capacity must be declared, and the guardianship of such person, if he is not a minor, ceases. 7. COST OF MAINTENANCE The probate judge may at any time inquire into the ability of " OI - any insane person committed by him to bear the expenses of his maintenance while in custody. If the insane person is able to pay Non-indigents. the charges or any portion of them, the judge must appoint a guardian for him, authorized to control all his property, and to pay from the proceeds of it the cost of his maintenance. Indigent ARIZONA 10 indigents. insane persons are maintained at the hospital at the expense of the state. 8. CRIMINAL INSANE County Whenever a person confined in any county jail in the state upon a Penal Code, conviction for a misdemeanor shows symptoms of insanity, the sheriff must immediately notify the county physician to examine the person, and, if in his judgment the person is insane, an examina- " 6 7. tion into his insanity must be held as provided by law. If found insane the person must be committed to the hospital for the insane. state convicts. When a prisoner confined in the state prison shows symptoms of insanity, the prison physician must examine him and finding him insane, must report to the superintendent. The superintendent must communicate at once with the nearest legal authority having jurisdiction concerning persons alleged to be insane, and thereafter all proceedings must conform to the law governing such cases. If the person is found insane, the superintendent of the prison must send him at once to the hospital for the insane, at the cost of the state. The superintendent of the hospital must render, quarterly, to the superintendent of the prison, a report of the condition of the person, and when he has so far recovered as to be able to continue service in the prison without further risk, he must be returned to serve any unexpired time. If his term of sentence has expired while in the hospital, the superintendent of the prison must forward him his legal discharge from the prison. under sentence If, after judgment of death, there is good reason to suppose that 1841. the defendant has become insane, a jury of twelve persons may be 1142- summoned to inquire into the supposed insanity. The district 1143- attorney must attend the inquisition. If the defendant is found insane, the superintendent of the state prison must suspend the execution of the judgment until he receives a warrant from the judge of the court in which judgment was rendered, directing the execu- 1144. tion of the judgment. If the defendant is found sane, the superin- tendent of the state hospital must immediately notify the gov- ernor, who must issue a warrant appointing a day for the execu- tion of the judgment. criminal If doubt arises as to the sanity of a defendant in a criminal case, the 1269. court must order the question as to his sanity to be submitted to a jury. If the jury find the defendant insane, the trial or judgment must be suspended until he becomes sane, and the court must order that he be committed to the state hospital and detained there until he becomes sane. When he becomes sane, the defendant must be taken from the hospital and placed in proper custody until he is brought to trial or judgment or legally discharged. 11 ARKANSAS Authorities : Kirby and Castle, Digest of the Statutes of Arkansas, 1915 Acts of 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of control for state charitable institutions control? is composed of three members, appointed by the governor" and con- '4667. firmed by the senate. Each member serves for six years, the terms being so arranged that an appointment is made to the board bien- nially. The annual salary of members, who are required to give full time to their official duties, is $2,500. The board appoints a secretary, who is required simply to be a bookkeeper and to keep a correct record of the proceedings. It reports to the governor biennially. The board is placed in full charge of all state charitable institu- tions, which include the hospital for the insane, the school for the feebleminded, the Confederate home, the school for the blind, and the deaf mute institute. It has no supervision over insane or feebleminded persons in private institutions or in jails or other local institutions, nor does its power extend to the state or local penal or reformatory institutions. The board appoints the superintendent and steward and pur- chases all supplies for the institutions over which it exercises control. The records of the board are open to the inspection of the gov- 4 ernor and all persons whom he or the legislature may appoint to examine them. The board is required to visit the institutions under its control at least monthly. The governor may at any time appoint a suitable person to * examine the affairs of any institution. b. Institutional. There is no local board of trustees. The super- intendent, who is appointed by the board of control, must be a skilful physician. He appoints and removes all subordinate officers and employees allowed by the board. His duties in regard to records, accounts, and the general care of the institution and its. inmates are prescribed in detail. 2. CARE a. In state institutions. State Hospital for Nervous Diseases, Little Rock; established 1882; 2,050 beds. The statutes require that negro patients shall be treated in rate wards or departments. ARKANSAS 12 b. In local institutions. Each county must provide in the county poorhouse, where such has been established, for its own indigent insane who can not be admitted to the state hospital, and the county court has the duty of looking after them. Insane per- sons may be confined in county or city jails. (See 3. b.) Classification of insane persons. 4753- Application. 4738. Hearing. 4739- Examination. Commitment. 4740. Notice of admission. 4741. 3. COMMITMENT a. Persons committed. Any citizen or resident of the state who becomes insane may be admitted to the state hospital as a patient, proper proof having been made and proceedings had according to the law. All inmates of the Arkansas Confederate Home who become insane and have been declared so by the physician in charge are entitled to care and treatment in the state hospital. All persons found to be insane, for whom application for admis- sion to the state hospital is made, are classified as "acute, " "chronic," "probably incurable," or "incurable." All cases of less than one year's duration from first recognized symptoms of insanity are classified as "acute"; all cases of over one year's duration as "chronic"; all cases complicated with epilepsy, original imbecility or feeblemindedness, deformities of skull from injuries, old age or paralysis as "probably incurable" ; and all other cases as "incurable" ; provided, that no person, whether curable or not, and whether the imbecility or insanity be idiotic or congenital or not, may be refused admission as long as there is unoccupied room for patients in the hospital. b. Legal procedure in commitment. Upon a written statement filed by any reputable citizen of the state with the county and pro- bate judge alleging that any person is entitled to admission to the state hospital for the insane, the county or probate judge must appoint a time as soon as practicable to hear the testimony of wit- nesses, and must cause the insane person to be examined separately by two reputable, competent and disinterested physicians, who shall severally present to the county judge a sworn statement of the result of their examinations. If the judge finds the person insane, he must without delay transmit to the superintendent of the state hospital his decision in writing, with copies of the original statement filed with him by the citizen, and the statement of the physicians including interrogatories and answers. The superintendent of the state hospital must thereupon immediately notify the judge of his readiness to admit the insane person. If there is no room, he must notify the judge, and return to him the documents in the case. But in such instances, the name and county of the insane person must be recorded at the hospital in the order in which the decision 13 ARKANSAS 454<5 - of the judge was received, and he is entitled to precedence over all who may apply for admission later. Insane persons found at large, and not in the care of some discreet foun person, must be arrested by any peace officer and taken before a magistrate of the county, city, or town in which the arrest is made, who shall make the necessary orders to keep him in restraint until he can be sent to the state hospital. If the insane person has no friends to whose custody the magistrate can commit him, he may order him to be confined in the county or city jail, giving immediate notice to the county judge or city "attorney, whose duty it is to take the proper proceedings for having the insane person sent to the hospital. Immediately after the appointment by the court of a guardian for an insane person, the guardian must take steps to have the per- son thus placed in his charge admitted into the state hospital. If any person is so far disordered in his mind as to endanger his J a e r ^f own person, or the person or property of others, his guardian, or other person under whose care he may be, must confine him in some suitable place until the next term of the probate court for his county, which shall make such order for his restraint, support and safe- keeping as the circumstances shall require. The judge or justice may order such confinement. Any judge of a court of record, or any two justices of the peace of the county may cause such insane per- son to be arrested, and may employ any person to confine him in some suitable place until the court makes further order. c. Voluntary admission. d. Appeal from commitment. e. Cost of commitment. Each county in the state is chargeable for all expenses of commitment, delivery to and removal from the state hospital of persons resident in the respective counties, and must reimburse the sheriff for money deposited with the superin- tendent for deficiencies of clothing of patients. 4. CONVEYING PATIENTS TO THE HOSPITAL The sheriff of any county, or any person deputized by the judge and directed to arrest and deliver to the superintendent of the state hospital any insane person, must execute the warrant or order with- out delay, and may call to his assistance a physician, nurse or other person whom the judge may indicate as necessary, and shall deliver the person without unnecessary force, restraint or publicity by the most direct and practicable route and method of travel. All females who have been adjudged insane must be accompanied to the state hospital by at least one female attendant. to the ARKANSAS 14 Acts of 1917, ch. 172. 2,3- Parole. Digest. 4766. Discharge. 4767. Superintend- ent may dis- charge, to make room for another. 4753- Notice of discharge. 4755- 4756. 5. TRANSFER OF PATIENTS The state board of control for charitable institutions may trans- fer to the school for the feebleminded, with the consent of its super- intendent, any feebleminded inmates of the state hospital for nervous diseases as may be more appropriately taken care of in the school. The superintendent of the state school for the feebleminded may select and requisition from other state institutions such of their feebleminded inmates as he considers most suitable for transfer, with due regard both to the welfare of the inmate and the benefit of the state. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of a state hospital may parole for six months any patient not convicted under a criminal charge nor transferred from a penitentiary or reform school if the patient is harmless to himself and the community; on written application he may extend 'this parole for another six months. At the end of the twelve months the patient may be discharged as recovered or held for further treat- ment. A responsible person may agree to give the patient proper care during the parole period and return him to the hospital without expense to the county. When there is no available room in the hospital, the superin- . tendent must, as soon as practicable, in order to make room for the admission of a patient suffering from an "acute" form of insanity, discharge some inmate belonging to the "incurable" class, if there is such, or one belonging to the "probably incurable" class if there is no one-dischargeable from the "incurable" class, or one belonging to the "chronic" class if there is no one dischargeable from the "probably incurable" class. In making a selection for discharge the superintendent must choose one who has been longest in the hospital, if not violent or dangerous to the community, or whose discharge will effect the least possible inconvenience or cost. No appeal may be had from the decision of the superintendent in mat- ters of admission and discharge of inmates, except to the board of control who may direct the superintendent to admit or discharge any person under any circumstances not involving a violation of law. When by reason of recovery or necessity for the benefit of an insane person of the "acute" class the superintendent of the state hospital thinks proper to discharge any inmate, he must notify the county and probate judge of the county from which the inmate was committed who shall then direct the removal of the inmate without delay to his guardian or home. If the patient has no guardian or home he must be delivered to such person and place in the county as may be provided for his further custody and maintenance, if he 15 ARKANSAS be not recovered and capable of taking care of himself. An inmate of the hospital having recovered his reason may unofficially be removed from the hospital by consent of the superintendent, or by his friends with consent of the superintendent, or by direction of the board of control. But notice of removal must be sent at once to the county or probate judge of the county from which the person was removed or committed. 7. COST OF MAINTENANCE Any indigent citizen or resident of the state, duly found to be At P ublic insane, may be maintained at the state hospital at the public expense 4746. until removed. If he has been found to possess estate more than B y estate - sufficient for the support of his natural dependents, his guardian must pay for his maintenance and care at the hospital, and remove him when so required and notified by the president of the board of control and superintendent of the hospital. Indigent persons who are not able to pay have preference over those who are able to pay. 8. CRIMINAL INSANE The superintendent of the state hospital, upon the certificate Admission, of the judge before whom the case is pending upon presentment 4 or indictment, must admit any person who has been acquitted upon a plea of insanity or any person who has been adjudged insane, when he has been held upon presentment or indictment and can not be tried because of insanity. Any person so admitted must be kept 4750. at the hospital until restored to reason. Upon his recovery, the 4751. superintendent must notify the sheriff of the county in which the indictment or presentment is pending, who shall convey him back Discharge, to the jail of said county, or hold him in custody until discharged according to law. When the penitentiary physician ascertains that any convict insane confined in the state penitentiary or reform school is insane, he 4752.' must certify the fact to the superintendent of the penitentiary or school who, by and with the advice and consent of the board of control, must transfer him to the state hospital. If the convict recovers, the superintendent must certify the fact to the superin- tendent of the penitentiary or school. The time the convict may have spent in the hospital is credited as time served under his sentence. 16 Board of control. Political code. Board of charities and corrections. General laws. 573- Commission in lunacy. Political code. 3136. CALIFORNIA Authorities: Deering, General Laws of California, 1916 Civil Code of California, 1915 Penal Code of California, 1915 Laws of California, 1917 Political Code i. ADMINISTRATION AND SUPERVISION a. General. The state board of control consists of three members appointed by the governor and holding office at his pleasure. The governor designates the chairman and fills all vacancies; the board appoints its secretary and other paid employees. The mem- bers receive an annual salary of $4,000. It is the duty of the board to examine the books of all state institutions, bureaus, commissions, and officers, to visit every public institution maintained in whole or in part by the state and all public buildings in course of construction. The board, with the consent of the governor, has the power to authorize the creation of deficiencies in cases of actual necessity; it also has the power to sell or exchange any property of the state, except real estate; and all claims against the state must be approved by it. The board has general supervision over all matters concerning the financial and business policies of the state, approves all state contracts for the purchase of supplies and materials, and, through its department of public accounting, maintains a uniform system of accounting and reporting for all public accounts and records. The board reports biennially to the legislature. The state board of charities and corrections is composed of six members, not more than three of whom may be from the same political party, appointed by the governor for terms of twelve years without salary. Women may be appointed. The board must in- vestigate and report upon all charitable and correctional institutions of the state, counties, cities and towns. All persons in charge of such institutions are required to furnish the board such informa- tion and statistics as it may request. The board may prescribe the forms of reports and records by the state commission in lunacy. All plans for buildings for public institutions must be submitted to the board. The board has power to compel the attendance of witnesses, the production of books and papers, relating to public institutions. The board makes a biennial report to the governor. A commission in lunacy, consisting of the general superintendent of the state hospitals, the secretary of the state board of health, 17 CALIFORNIA the three members of the state board of control, and the governor, secretary of state, and attorney general, ex-officio, exercises general supervision over the state hospitals for the insane. The general superintendent of state hospitals is appointed by the governor 2 '37. for a term of four years, and may not hold any other office. His salary is $5,000. He must be a reputable physician, a graduate of . an incorporated medical college, and have .had at least ten years' actual practice in his profession as well as six years' experience in the care and treatment of the insane, at least one year of which must have been spent in the state hospitals. He must fully inspect 2 every state hospital at least twice each year. The commission is authorized, among other things, to appoint an accountant for the hospitals and to inquire into their general condi- tion and management; to fix the annual salaries of the resident officers and treasurers of the hospitals, which must be uniform for all, and to classify other officers and employees and determine their salaries; to determine the kind and character of all employees in state hospitals. The commission must examine the condition and management of all public and private institutions receiving and caring for the insane; adopt rules and regulations, books of record, blank forms, etc., for all hospitals; keep a record of each duly qualified medical examiner and of all inmates of hospitals; cause the books and accounts of the hospitals to be examined at least once in six months; report and recommend to the legislature the necessary prospective needs for the care and treatment of the poor and indigent insane; and, for the purpose of preventing over-crowding, make suitable recommendations to the legislature; furnish the legislature an estimate of the probable number of patients who will become inmates of the respective state hospitals during the two years begin- ning July first, next ensuing, and the cost of all additional buildings and equipments; and report to the legislature its acts and proceed- ings. The commission has power to investigate cases of alleged wrongful detention of insane or their improper treatment, and may for this purpose exercise the powers conferred upon the referee in a superior court. At an investigation into the general management of any hospital for the insane, the commission may notify the at- torney general, who must participate personally or by a deputy. The commission may at any time visit and examine the inmates of . any almshouse to ascertain if insane persons are kept there. No private institution for the care and treatment of the insane ?" s v * te j may be established without first obtaining a license from the com- 2J 96. mission. Application for a license must be accompanied by plans and other information, in such form as the commission may require. CALIFORNIA 18 Before granting a license, the commission must inspect the place and, after inquiry, amend or revoke any license. Private institutions for the care and treatment of the insane must keep records in the saem manner and form as prescribed for the state hospitals. For violating the provisions of law in regard to private institutions for the insane, a penalty may be imposed of imprisonment for six months, or a fine of $1,000, or both. Board of 1 [)> Institutional. Each of the hospitals for the insane is under a "47- board of five managers, appointed by the governor for terms of four years. Failure on the part of a manager to attend the regular meetings of his board unless ill or absent from the state makes his 3I t 8 - office vacant. Subject to the powers of the state commission in lunacy, each board of managers has general control and direction of ai s- the property and concerns of its hospital. Subject to the approval of the commission, the board must make laws and regulations in regard to the duties of officers and employees; visit the hospital at least every month (the attendance of the majority is required); and make detailed reports of visits and inspections to the commis- "5 1 - sion in lunacy. No money may be expended by the managers for ai s- additional buildings or unusual repairs except upon plans and specifications approved by the commission. ^perStendent Each board of managers appoints for the hospital under its control a medical superintendent (subject to an examination un- der the direction of the general superintendent), and a treasurer. The former must be a graduate of an incorporated medical college and a well-educated physician, who has had not less than three years' experience in the care and treatment of the insane. 31538. The medical superintendent appoints, with power of removal, by and with the consent of the board of managers: a supervisor, matron and steward and all employees; the necessary assistant physicians and internes, as may be determined by the commission. At least one of the assistants in each of the state hospitals must be a woman. The assistant physicians must have had actual experience in the care and treatment of the insane, and before appointment are required to pass an examination conducted by the medical superin- tendent. Any officer or employee of a state hospital taking active part in politics, directly or indirectly, may be summarily removed by the commission upon written charges, under oath, made by three or more reputable citizens. 2. CARE a. In state institutions. Stockton State Hospital for the Insane, Stockton; established 1851; 1,900 beds. 19 CALIFORNIA Napa State Hospital, Napa; established 1875; 2,200 beds. Agnews State Hospital, Agnew; established 1888; 1,600 beds. Mendocino State Hospital, Talmage; established 1893; 1,150 beds. Southern California State Hospital, Patton; established 1893; 2,000 beds. Norwalk State Hospital, Norwalk; established 1914; 233 beds. b. In local institutions. Chronic harmless and other insane who Bounties, are not suitable patients in the state hospital may be cared for in county hospitals or almshouses, which are under the boards of supervisors of the county. The board of supervisors of each county, and city and county, *^ on - must maintain a suitable room or rooms for the detention, care and 3l8 3- treatment of alleged insane persons, for a period of not less than one nor more than twenty days. All peace officers and other persons having duties relative to the insane poor must see to it that all poor and indigent insane persons within their municipalities are speedily granted relief, and when ordered by a superior judge must cause them to be transferred with- out unnecessary delay to the proper state hospitals. 3. COMMITMENT a. Persons committed. All insane persons are entitled to ad- 31 7sa. mission to the state hospitals for the insane; but no case of idiocy, imbecility, epilepsy, harmless chronic mental unsoundness, feeble- mindedness or acute mania from drinking may be committed to the state hospitals, except when the person has become insane. The commission in lunacy may inquire into the manner in which ax 7?. any insane person not confined in a state hospital is cared for, and may apply to a judge of the superior court for commitment to a state hospital. If a poor or indigent person who has not been a legal resident the state for a period of at least one year, is ordered to be committed to a state hospital, the commission may return him to the coun- try or state to which he belongs. b. Legal procedure in commitment. The superior judge of county, or city and county, may grant certificates to medical 21678. examiners in accordance with the form prescribed by the commission, showing that the persons named are reputable physicians and graduates of incorporated medical colleges, and have been in a tual practice at least five years. There must at all times be at least two such medical examiners in each county. Whenever it appears by affidavit to the satisfaction of a magistrate Afl ^g it * of a county, or city and county, that any person is so far disordered in his mind as to endanger health, person or property, he must have CALIFORNIA 20 Hearing. 2i6p. Examination. am. Commitment. Jury trial. Examination at hospital. 2186. 1643. him taken before a judge of the superior court of the county for a hearing. The copy of the affidavit and warrant of the arrest must be personally delivered to the alleged insane person. The judge of the superior court must inform him that he is charged with being insane and of his rights to make a defence, and order a time and place for a hearing of the case and examination in open court. The judge may also order that notice of the arrest and hearing be served upon relatives of said person residing in the county. At least two medical examiners must hear the testimony of all witnesses, make a personal examination of the alleged insane person, and testify before the judge as to the result of the examination, and to other pertinent facts. The judge must examine any other proper witness who has any knowledge of the mental or financial condition of the alleged insane person or financial condition of the persons liable for his maintenance. The alleged insane person must be present at the hearing, and if he has no attorney, the judge may appoint one to represent him. If the medical examiners believe the person to be dangerously insane, they must make a certificate to that effect in the form prescribed by law, whereupon the judge, if he believes the person so far disordered in his mind as to endanger health, person or property, must adjudge him insane and issue an order for his con- finement in a hospital for the insane, accompanied by a statement as to the financial condition of the insane person or the persons liable for his maintenance. Copies of the order, the certificate of the examiners and accompanying statement must be filed with a county clerk and recorded by him. If a judge refuse to grant an order of commitment of an alleged insane person, any one ag- grieved may demand a trial of the question in the manner provided for a jury trial. Every superintendent of a hospital must within three days after the reception of a patient have him thoroughly examined physically and mentally. He must also make such examination periodically and state results upon blanks approved by the com- mission. c. Voluntary admission. Under rules and regulations established by the state commission in lunacy, the medical superintendent of any state hospital may receive and detain in such state hospital, as a boarder and patient, any suitable person suffering from mental disease, who voluntarily makes a written application to the medical superintendent for admission and who is competent to make such application. A voluntary patient may not be detained for more than seven days after having given notice in writing to the medical superintendent of his desire to leave. Upon the admission of a voluntary patient to a state hospital, the medical superintendent 21 CALIFORNIA must immediately send the commission in lunacy his record, show- ing name, residence, age, sex, nativity, occupation, civil condition, date of admission and other information that may be required. d. Appeal from commitment. If a person ordered to be com- ai ?4- mitted, or any friend in his behalf, is dissatisfied with the order committing him, he may within five days demand that the question of his sanity be tried by a jury before the superior court of the county J^y tiia1 ' in which he was committed. The cause against the alleged insane must be represented by the district attorney of the county. The trial is held as provided for the trial of civil causes before a jury, and the alleged insane person must be discharged unless a verdict that he is insane is found by at least three-fourths of the jury. Any one in custody as insane is entitled to the writ of habeas H ^|| s corpus> corpus, upon proper application made by the commission, by such person, relative or friend in his behalf, to the superior judge of the county in which the hospital is located. e. Cost of commitment. The cost of determining the insanity . of an indigent person and securing his commitment is charged upon the county, or city and county, whence he is committed. If he is not indigent, the costs are charged upon his estate, or to the persons legally liable for his maintenance. If he is adjudged not to be in- sane, the judge may charge the costs of the proceedings to the person making the application for an order of commitment. The husband, 2I76 - wife, father, mother or children of an insane person/ and the guardian of his estate, are liable for the cost and charges of his commitment and transportation to a hospital for the insane. 4. CONVEYING PATIENTS TO THE HOSPITAL It is the duty of the sheriff to deliver the insane person together ai72 ' with all documents in his case to the officer in charge of the hospital to which he is committed. No female insane person may be taken to any hospital without the attendance of some other female or of some relative. 5. TRANSFER OF PATIENTS When the buildings of any hospital are overcrowded or the number ^j^-ssion * is reduced, the commission may transfer the inmates to other in-^f^l** I IT stitutions. Patients may be transferred at the request of relatives or friends upon agreement to pay the cost of the transfer, if the lunacy commission and the superintendents of the hospitals consent. Inmates of the home for the feebleminded who become insane may be transferred to a hospital for the insane and persons committed to an insane hospital who are feebleminded may be transferred to the home for the feebleminded by the board. The transfer may not relieve any one from liability for the support of any inmate. CALIFORNIA 22 3189. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of a hospital may grant parole to a patient for not more than thirty days under provisions prescribed by the commission. by s the arge The superintendent of a state hospital on filing a certificate with superintendent, the secretary or board of managers may discharge any patient, except one held upon a court order in a criminal action, who has recovered, or one not recovered whose discharge will not be detri- mental to public welfare or injurious to himself. The medical superintendent may refuse to discharge any patient as improved unless satisfied that proper care will be provided for him after his discharge. When the superintendent is unwilling to certify to the discharge of an unrecovered patient upon request, any superior By the court, judge of the county in which the hospital is situated may, after giving the superintendent an opportunity to be heard, direct the discharge upon such security as he may require for the good be- havior and maintenance of the patient. of'noifinsane The me dical superintendent of any state hospital may on his own motion, and must on the order of the commission, discharge any patient who is not insane or because he is not a proper case for treat- ment, or because he is an idiot, imbecile or on account of chronic harmless mental unsoundness or acute mania from drinking. Such a person must be returned to the county from which he was com- mitted at its expense, and if poor and indigent, must be cared for by the county. Any person thus discharged from a state hospital may not again be committed to any state hospital for the insane except upon permission obtained from the medical superintendent. When any person committed to a state hospital, and for whom no guardian has been appointed, and who is absent on parole, or who has been discharged as improved, is desirous of being declared sane and restored to legal capacity, he or others on his behalf may make application in writing to the medical superintendent. If satisfied after examination that the person is sane, the medical superintendent must so declare him, and give him a certificate of his recovery, a copy of which is to be forwarded to the commission. If the medical superintendent is unwilling to issue such certificate, the insane person or others on his behalf may petition a judge of the superior court of the county wherein such person resides, asking that he be declared sane. If the court is satisfied, and the jury so decides, the court must adjudge him sane, and the order to that effect must be recorded by the county clerk and certified to the commissioners in lunacy and the proper hospital superintendent. If the court is satisfied, or the jury so decides, the court shall adjudge him to be insane. If the question is tried by a jury, the cause against the Restoration of insane to legal capacity. Certificate of recovery. Jury trial. 23 CALIFORNIA insane person must be represented by the district attorney of the county. An appeal may be taken from the decision of the court to the supreme court. If three-fourths of the jury fail to declare the person sane, or the court or jury find him insane, the court must dismiss the case and no new application shall be made for the in- sane person for six months thereafter. Proceedings of the same kind may be taken whenever a person who has been adjudged to be insane and who has not been committed to a hospital for the insane and who has no guardian, is desirous of being declared sane and re- stored to legal capacity. Before an order is made for any proceed- ings for a trial by jury, the persons demanding the same must make a deposit or give a bond for the payment of all costs of the trial, unless in the opinion of the court he is a poor or indigent person. Patients discharged must be furnished with suitable clothing 3I 9- and money for necessary expenses, not exceeding $25. 7. COST OF MAINTENANCE Indigent insane persons are maintained at the state hospitals ^j*^* 8 - at the expense of the state. The district attorney in each county must inquire into the ability of a person committed from his county to pay for his support at the state hospital and notify the commission in lunacy of the results. In case any person committed to any state Nonindigents. hospital for the insane becomes the owner of property, the secretary of the state commission in lunacy may apply to a court of competent jurisdiction for the appointment of a guardian of his estate, which if sufficient is to be used for his support at the hospital. Payment 2181. may be enforced by the order of the judge of the superior court. But payment may not be exacted when, in case of the likelihood of such person recovering or being released from the hospital, it will reduce his estate to such an extent that, in the event of his discharge, he is likely to become a burden upon the community. Pay patients may be received under special agreement with Pa /i8s! ients * relatives, guardians or friends of patients. 8. CRIMINAL INSANE If a defendant in a criminal case appears to be insane before judg- 1 ^^^^ ment is pronounced, the question of sanity is submitted to the jury. Pe 1 n 1 a ( | 7 code - If found insane he is committed to a state hospital to remain till the superintendent notifies the sheriff and district attorney that the patient has recovered. The patient, upon certificate of recovery 2l8j> - approved by the superior judge of the county from which he was committed, is then delivered to the sheriff of the county and dealt with as provided in the penal code. The time spent at the hospital counts as time served on the sentence. CALIFORNIA 24 1368. When a defendant is acquitted on the ground of insanity the court may summon a jury to inquire whether the insanity continues. If it is so decided, he is committed to the state hospital, convicts When the warden of one of the state prisons and such other officers 's 8 ?- as may be designated by the directors of the same to act with him in such cases, believe any convict to be insane, after proper examina- tion, the warden must certify the fact to the superintendent of one of the state hospitals for the insane, and send the convict to the hospital. If at the expiration of the term of sentence the insane convict is still in the hospital, he must be allowed to remain there until discharged as cured. When, in the opinion of the superin- tendent, the insane convict is cured of insanity, he must notify the directors of the prison and the warden who must receive the convict back into the prison, the time passed at the hospital counting as a part of his sentence. Before discharging a convict who may be insane at the time of the expiration of his sentence, the warden must notify a judge of the superior court of the county in which the prison is located of the fact of such insanity. The court must order the sheriff of the county to take the insane convict before the court. If satisfied after having him examined by medical experts that the convict is insane, the court must order him to be confined in one of the state hospitals. 25 COLORADO Authorities: Mills' Annotated Statutes of Colorado, 1912 Session Laws of Colorado, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities and corrections consists of six persons appointed by the governor with the consent of the senate for a term of six years, two members retiring every two 6 3> years. The governor is ex-officio a member of the board, and may remove any member of the board. Members of the board receive no compensation, but employ a salaried secretary. The board has power to investigate the whole system of public charitable and correctional institutions which derive their support wholly or in part from state, county or municipal appropriation. Officers of such institutions must furnish the board such informa- tion, statistical or otherwise as may be demanded. The board must make a biennial report to the governor. The state board of corrections, composed of three commissioners Sections appointed by the governor for terms of six years, has full con-j* s 2 . f IpIS * trol, management, and supervision of the state hospital for the insane, the state penitentiary, and the state reformatory. Each commissioner receives $1,200 per annum and actual expenses. The board of corrections has full control and supervision of all st ^ I t | s- the property, grounds and buildings of the state hospital, and its entire government. It prescribes rules and by-laws for the manage- ment of the hospital and its inmates, and for the government of its officers and employees, and must make proper provision for the reception, treatment, discharge and transfer, either from or to other institutions or from the hospital to family care and the return therefrom, of all inmates who may be committed to the hospital. The probate judges of the several counties appoint for terms of ^* t r d r f county three years six persons, three of whom must be women, to constitute 6is - a county board of visitors. Each board must visit at least once in three months all charitable 616. or corrective institutions that are under county or municipal control and recommend necessary changes and improvements. Each 6r7 - board must file an annual report with the state board of charities and corrections. b. Institutional. There are no local boards of trustees. The Superintendent, commissioners appoint a superintendent to hold office during their pleasure, who must be a physician, a graduate of an incor- COLORADO 26 4718. porated medical college, of at least five years' actual experience in a 4717. hospital for the treatment of the insane. The commissioners may provide for an assistant superintendent who must be a physician of at least five years' practice in his or her profession, two or more res- ident physicians, one of whom must be a woman, and for such other assistants and employees as may be necessary, and fix their respec- tive salaries. All assistants and employees are selected and ap- pointed by the superintendent, subject to the approval of the commissioners, and hold their positions subject to rules and regula- tions of the commissioners. The hospital for the insane maintained by the city of Denver is under the control of the municipal authorities. 2. CARE a. In state institutions. Colorado State Hospital, Pueblo; estab- lished 1879; 1,200 beds. b. In local institutions. The city of Denver maintains a depart- ment for the insane connected with the city and county hospital. Insane persons who can not be provided for in the state hospital may be maintained in county infirmaries, under the control of the board of county commissioners, the chairman of which is ex-omcio overseer of the poor. 3. COMMITMENT ch!?!? IJ>1S> a * Persons committed. The term "insane person" includes idiots, x - and any person so insane or distracted in his mind as to endan- ger his own person or property, or the person and property of Laws of 1917, others, if allowed to go at large. All persons adjudged insane are* wards of the state. It is the duty of the board of corrections to admit them to the state hospital or provide and care for them elsewhere. b. Legal procedure in commitment. Whenever a reputable per- son files with the county court a duly verified complaint alleging that any person in the county is so insane or distracted in his mind as to endanger his own person and property or the person and property of others, if allowed to go at large, the county court must have the patient taken into custody. If a sheriff or constable finds such an insane person at large in his county, he must apprehend him without an order of court. To the insane person so arrested must be delivered a copy of the complaint and order. The judge issuing the order may designate a hospital or other convenient suitable place for detention until he shall determine whether an examination into the mental condition of the person is desirable. If apprehended without an order the insane 27 COLORADO person must be taken before the county court which determines forthwith whether an examination is desirable, but may order the person confined, observed, treated and cared for temporarily. The judge appoints a lunacy commission of two physicians resident J; in the county (if only one physician is available a layman may be substituted). No member of a lunacy commission shall be a rela- * tive of the person alleged to be insane, or a manager, superintend- l6 - ent, proprietor, officer, stockholder, or have any pecuniary interest, directly or indirectly, or be an attending physician, in the insti- tution to which it is proposed to commit such person. The commission examines the person in the presence of a guardian Examination, ad litem to be appointed by the court. Subpoenas must be issued to procure the attendance of witnesses desired by a commission, guardian or county attorney. A lunacy commission has power to administer oaths and the right to examine witnesses whether they are subpoenaed or not. The commission must report within 48 6 - hours of its first session and notice of the presentation of report must be given to the board of county commissioners or county attorney. The judge must approve the findings and if the person is dangerous commitment, to be allowed at large, must commit him to the state hospital or other suitable place. Every inquest in lunacy must be brought in the name of the people 3 of the state of Colorado, and be prosecuted by the county attorney of the respective county, or in case of his absence or inability, by a duly qualified attorney or other suitable person. No inquest may be ** had as to the lunacy of a person charged with a criminal offense until such criminal offense has been tried and dismissed unless the judge of the district court wherein the offense is pending shall order such inquest. No insane person may be confined in any city or county jail un ~ n t a t e b p e erson less he is violent and his absolute safety demands such confinement, ffi*** in and then only upon an order from the county court, under the pen- statutes, alty of a fine of $10 to $100 or imprisonment for 10 to 90 days, or both. Under no conditions may he be confined in any jail for a longer period than ten days. A physician testifying to the insanity of any person for the purpose Physician of securing his commitment to custody must be of reputable char- luna cy. acter, a graduate of some incorporated medical college, a permanent resident of the state, in the actual practice of his profession, and not connected with any institution for the insane. The possession of such qualifications must be certified by the judge of a court of record, and his certificate shall constitute such physician an examiner in lunacy. To act as medical examiner in lunacy cases without 4704. authority is punishable by a fine of $50 to $300 or imprisonment from COLORADO 28 30 to 90 days, or both. This provision does not prevent the super- intendent from testifying in lunacy cases. en^ma" 'admit c< Voluntary admission. The superintendent of a hospital or 4723- other institution for the treatment of the insane may receive and detain as a patient any person who desires treatment and makes written application therefor, but whose mental condition is not such as to render it legal to grant a certificate of insanity in his case; but no patient may be detained more than three days after having given notice in writing of his intention or desire to leave. Voluntary patients must pay their cost of maintenance. Jawso^'i d. Appeal from commitment. Any person ordered to be commit- ch.iis. " ted or any friend or any person interested in the proceedings may within five days after the order of the judge, demand in writing that the questions considered by the commission be tried by a jury of six men. At such trial the cause against the person complained of must be represented by the county or district attorney or by some one appointed by the county judge and the court shall appoint a guardian ad litem unless the patient appears by his own counsel. ftatutes C rpus ' ^ P erson > n t committed or detained for any crime or supposed 3344- criminal matter, who is restrained of his liberty,' may apply for a writ of habeas corpus to the circuit or district court. The applica- tion, signed by the party or some person on his behalf, must state the facts concerning his confinement and in whose custody he is detained. 3365. Any county court or county judge in the state is authorized to issue the writ of habeas corpus in the absence of the circuit court or district court. 4696. e. Cost of commitment. Expenses attending any inquest in insanity are paid out of the estate of the insane by the conservator upon the order of the county court, but if there is no estate, or if any original inquest results in discharge, the county commissioners of the proper county must allow them. 4. CONVEYING PATIENTS TO THE HOSPITAL attendant ^ e J u dge of the county court must designate some trained at- tendant to accompany the insane patient to the state hospital, 7- and every female patient must be accompanied by a female attend- ant unless accompanied by her husband, father, brother or son. This attendant shall have entire control of the patient until delivered to the place of commitment. The judge may make any other order relative to the persons to accompany the patient as to him seems proper. 29 COLORADO 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of the state hospital has the power to issue |jjj2 n ' a probationary discharge if he believes it to be for the best interest 4696. of any patient under his control. When any person confined in the state hospital has been restored to reason, the superintendent must Discharge, discharge him and notify the judge of the county court by which the patient was adjudged insane that the insane person has been restored to reason and discharged. Paupers when discharged must 4697. be furnished with a sum of money, clothing, and transportation to their homes. If a reputable person present to the county court of any county JJ^jlJ** 8 where a person is confined as an insane person, other than in the institutions, state hospital, an application in writing for his discharge on the ground that he has been restored to reason, the court must appoint two reputable physicians to make inquiry, and at least one of whom must not be officially connected with the institution where the patient is confined. If it is found that the patient has been restored to reason, he must immediately be set at liberty. 7. COST OF MAINTENANCE ained of has real -md If the commission reports that the person complained of has real -md igen ts. or personal estate or if this fact comes to light at any time after- ward, the court appoints a conservator, who applies the estate to the patient's maintenance. Relatives and next of kin are liable for is. a patient's support. If the patient has no estate, he is supported In |igents at the expense of the state. Whenever any county expends any money in the necessary sup- statutes. port, maintenance or preserving in custody of any insane pauper, the county must be reimbursed from the fund for the support of the insane by the auditor of the state. 8. CRIMINAL INSANE There may be committed to the ward for criminal insane : danger- ous persons who have committed high crimes or misdemeanors; persons chaiged with committing such crimes who are believed to feign insanity or in regard to whose insanity there may be so great a doubt so as to require the investigation of examiners; persons acquitted of such crimes on the ground of insanity; persons charged with the commission of any crimes who become insane before trial or sentence; persons becoming insane while in prison after conviction of any crime, and continuing insane throughout the term of sentence, who have no friends or relatives to whom they may be delivered at COLORADO 30 the expiration of sentence; and insane convicts generally whose insanity has been ascertained, and who may be transferred from penal institutions. Recovery. Upon the recovery of any person who has been transferred from the state penitentiary or state reformatory to the state hospital, it is the duty of the superintendent of the hospital to notify the warden of the state penitentiary or state reformatory, who must transfer the person to the place of his former commitment for the purpose of serving out his sentence, if it has not expired. 31 CONNECTICUT Authorities: General Statutes of Connecticut, 1902 Public Acts of Connecticut, 1903, 1905, 1909, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities is composed of members, two of whom are women, appointed by the governor terms of four years, subject to removal by him for cause. The 286s - members receive no compensation for their services. 2864> The board must meet at least once in two months. It must m- spect all institutions in which persons are held under compulsion, to ascertain how they are treated and whether properly held and may correct any abuses found, through the persons in charge of the in- stitutions. The state institutions must be visited once in three months by at least one member of the board of each sex. All a766 - hospitals for the insane must be visited and inspected at least once in six months. The board must appoint three supervisors of children supervisors, in state institutions. The board reports annually to the governor ^^ of J $>o3, and general assembly. Private hospitals for the insane must be licensed by the governor. {^j. v !tais An application for license must show the proposed location, the 8 ^^ 68 - number of persons for whom accommodations will be provided, and the previous experience of the applicant in the care and treatment of the insane. The physician in charge must be registered and have at least three years' experience as medical attendant in some in- stitution for the insane. The license may be revoked by the gov- ernor upon proof that the institution is improperly conducted. The penalty for carrying on a private hospital in violation of law is a fine of not more than $1,000 or imprisonment for six months, or both. b. Institutional. The state hospitals are under the immediate g^^of management of boards of trustees consisting of the governor and twelve trustees, appointed by the senate, one from each county and four from the vicinity of the hospital. The trustees have charge of the general interests of the hospitals, a ?75. appoint and remove all the officers and attendants, fix their com- pensation, and make rules and regulations for the conduct of the institutions. The superintendent must .be a competent physician and may be Superintendent, authorized by the trustees to admit patients under special arrange- a ' 78 - ment when there are vacancies. CONNECTICUT 32 Removal from alms- houses. Acts of 1915, ch. 294. Jurisdiction. 2736. Hearing. 2738. 2. CARE a. In state institutions. Connecticut Hospital for the Insane, Middletown; established 1868; 2,720 beds. Norwich State Hospital for the Insane, Norwich; established 1903; 1,230 beds. Public patients are occasionally sent to the Hartford Retreat, a private institution, Hartford; established 1824; 165 beds. Such patients are maintained in part by the state, the major part of the cost of maintenance being paid by the towns in which they have a legal settlement. The state prison has an insane ward for males, with a normal capacity of 40 beds. b. In local institutions. There are no local public institutions for the insane. The authorities in charge of almshouses must have all inmates examined by a physician at least once in six months and institute proceedings for the commitment of any insane persons found there. In case any town fails to institute such examination the state board of charities shall do so at the expense of the town. 3. COMMITMENT a. Persons committed. All insane persons who are residents of the state are entitled to admission to the state hospitals. Non- resident insane paupers may also be committed. b. Legal procedure in commitment. The jurisdiction of the commitment of an insane person to a hospital is vested in the court of probate for the district in which the person resides, or in which he may be at the time of filing the complaint, except in cases where it is otherwise expressly provided by law. Courts of probate may exercise such jurisdiction only upon written complaint, which may be made by any person. If an insane person is at large and dangerous to the community, the selectmen of the town in which he resides or is at large, must make complaint. Except when other- wise specially provided by law, no person may be committed to a hospital for the insane without an order of a court of probate ; except in cases of sudden and violent insanity, when he may be detained in a hospital for not more than 48 hours without special order of a court of probate, but proceedings must forthwith be commenced in that court. Within ten days after a complaint has been filed, the probate court must appoint a hearing, giving due notice to the person al- leged to be insane and to others concerned. The court may also cause the person complained of to be brought before it to see and 33 CONNECTICUT examine him, if in its judgment his condition or conduct renders it necessary and proper so to do, or state in its final order w^iy it was not necessary or advisable so to do. While the proceedings are * 739 - pending, the court may order the restraint of the alleged insane 27 4- person. The court must require, in addition to any oral testimony, the sworn certificates of at least two reputable physicians, who are graduates of legally organized medical institutions and have been practitioners of medicine at least three years within the state, and are not connected with any asylum nor related to the complain- ant, nor to the person alleged to be insane. One of the physicians is to be selected by the court. The certificate of the physicians must state that they have personally examined him within ten days of the hearing, and that in their opinion he is insane and a fit subject for confinement in a hospital. If the court finds that he is insane and a commitment, fit subject for treatment in a hospital, it must order his commit- ment to a hospital, to be confined while the insanity continues, or until discharged in due course of law. When a pauper in any town is insane, a selectman of the town may apply to the court of probate for the district in which the ch j335. pauper resides for his commitment to a state hospital for the insane, and the court must appoint two reputable physicians to investigate the facts of the case and report to the court. If they find the pauper insane, the court may commit him to one of the state hospitals for the insane. When an indigent person not a pauper is insane, application may be made by any person or the selectmen in his behalf to the court of probate for the district in which he resides, and said court -must ap- point two reputable physicians, and a selectman of the town of the indigent person to investigate the facts and report to the court. The selectman must include in his report a statement of the facts relating to the residence of the person, and an estimate of the value of his estate so far as it can be ascertained. If the court of probate is satisfied that the person is indigent and insane and a resident of any town within its jurisdiction, it must order him to be taken to one of the state hospitals for the insane. The judge making the order of commitment must state the towji of which the indigent insane person is a resident and the reported amount of his estate. No court of probate in this may commit to an insane hospital within the state a person who is found by it not to be a resident of a town within the jurisdiction of the court. Whenever a court orders the admission of a pauper or indigent Jj*'^ 1908 ' person to a state hospital for the insane, it must record the order, I - and give a certified copy of it and of the proceedings to the person by whom the patient is to be taken to the hospital and transmit a copy CONNECTICUT 34 25peS deBt Acts of 1917, 9- statutes. ?roedSgs. f 19I7> s I tat > ut a e's COrpus ' to the governor. In case neither of the state hospitals for the in- sane can accommodate the person to be committed, the court may commit such person to another suitable asylum or hospital. Any insane pauper, not a resident of any town in the state, may be committed by the governor to any suitable place of de- tention upon presentation of the sworn certificate of two phy- sicians of recognized standing, that they have found upon examination that the person is insane; in case the commitment is to be made to a state institution, the certificate must be upon a f rm prescribed by the attorney-general. Any person who has suddenly become insane and is in need of treatment may, upon application and the certificate of a physician, be admitted to any hospital for the insane, public or private, for ten days. If fur- ther treatment is needed, the superintendent must apply for commitment. c * Voluntary admission. Any hospital may receive for observa- tion and treatment any person who in writing requests to be re- ceived; but no such person shall be confined in any hospital for more than ten days after he has given notice in writing of his desire to leave, without commitment from some court of compe- tent jurisdiction. d. Appeal from commitment. Any person, relative or friend has the right to appeal from the order of the court on behalf of any person found to be insane. The court of probate, on such appeal, must order notice given to the parties to the proceedings and to other persons as it may deem proper; and may require an appellant to give bond to pay all legal costs and expenses of the hearing if successful. On the trial of an appeal, the superior court may re- quire the state's attorney to be present, for the protection of the interests of the state and public. Pending an appeal to the superior court, it may make provisions for the care of the person complained of. Anv P erson committed or any person interested may apply to the cour t f r a revocation of the order. The court must give notice to all parties concerned, hold a hearing and determine the application. ^ insane persons confined in any institution in the state are en- titled to the benefit of the writ of habeas corpus, and the question of insanity must be determined by the court or judge issuing it. If the court decides that the person is insane, this decision is no bar to issuing such writ a second time, if it is claimed that the person has been restored to reason. ^ n m ^ rma tion that any person is unjustly confined in any insane hospital, or in any neighborhood hospital in this state, or in the custody of any individual under an order of a court of probate, any 35 CONNECTICUT judge of the superior court may appoint a commission of not less than two persons to inquire into the case. If in their opinion the person is not legally detained, or is cured, or his confinement is no longer beneficial or advisable, the judge must order his discharge; but no commission may be appointed with reference to the same person oftener than once in six months. The judge before whom the proceedings are had may tax reasonable costs at his discretion. e. Cost of commitment. All fees and expenses incurred by Pe ns liable, commitment proceedings must be paid out of the estate of the person found insane, if he has sufficient estate, and, if not, by his relatives liable to support him, if of sufficient ability, and if there are none such, then by the town to which he belongs. In case the person is found not to be insane^ the fees and expenses must be paid by the complainant. 4. CONVEYING PATIENTS TO THE HOSPITAL State hospitals and other hospitals for the insane must, if pos- fi y hospital sible, when requested by an officer of the court, send properly L ws p f ^T. trained attendants or nurses to attend any hearing concerning 3- the commitment of an insane person, and such attendant or nurse when present must be designated by the court as the authority to serve the commitment. If no other attendant is ap- pointed by the court, the selectmen of the town must provide for the conveyance of the patient to the hospital. In appointing a person to convey the insane patient to the hos- statutes, pital, the court must give preference to a near relative or friend of the insane. Unless a female patient is in charge of a member 2 ?5o. of her own family, the court must direct that at least one adult female shall accompany her. 5. TRANSFER OF PATIENTS The governor may at any time cause an inmate to be transferred ^^or from one state hospital to another as circumstances, in his judgment, ^ 9 6 f I9 s may require. 6- Any inmate of any institution for the feebleminded, epileptic or By^he court, insane may be transferred to any other institution by the court ch -33s- making the original commitment. The institution from which the transfer is made must pay all of the costs. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of any institution for the insane may, under Par ^f n ^ n *ent such restrictions or agreements as he deems proper, permit any $* of I9 9 ' inmate to leave the institution temporarily, in charge of his guardian, * relatives, friends, or by himself, for a period of time not exceeding six months. The original order of commitment remains in force CONNECTICUT 36 Discharge by the trustees. . Acts of 1915, ch.p. Discharge by the court. Statutes. 2756. Paupers. Acts of 1917, ch. 335. Indigents, ch. 219. Acts of 1905, ch. 196. Non-resident paupers. Acts of 1917, ch.335- Examination of accused who appear t be insane. Statutes. 1472. Disposition of accused acquitted on the ground of insanity. 1473- and effective until the patient is officially discharged by the authori- ties of the institution. He may be returned by his guardian, rela- tives, or friends, or by himself, or may be recalled by the authorities of the institution at any time during the six months. The expense, if any, of such recall or return is, in the case of an indigent, to be paid by those responsible for his support, or, in the case of pauper, by the town of which he is a resident. The officers, directors or trustees of a state hospital when notified by the superintendent that a patient is not insane or a proper subject for confinement may petition the superior court to order his discharge. A copy of the petition shall be served upon the selectmen of the town to which the person belongs. If of the. opinion that the patient is not legally detained or cured or no^ longer benefited by confinement, the judge shall order his discharge or direct other disposition. Any person held in confinement as an insane person under the order of a court of probate may, upon proper application and satis- factory proof that he has been restored to reason, be ordered dis- charged by such court. 7. COST OF MAINTENANCE In the case of an insane pauper, the town whose selectman ap- plied for commitment must pay $2 per week for his support at the hospital, the balance being paid by the state. In the case of an indigent person not a pauper, the person making the application must pay a reasonable amount for his support, the balance being paid by the state. Provision is made for the recovery by a town from a person liable for the support of a patient or from any town to which a person is chargeable. The support of insane paupers who are not residents of any town in the state (who may be committed by the governor to any suitable place of detention) is paid by the state to an amount not exceeding $3.75 per week. 8. CRIMINAL INSANE When a person committed for trial to the county jail appears to be insane, a judge of the superior court on application of the sheriff may appoint three physicians to examine him; and if the physicians find him insane, the sheriff must, upon the order of the judge, transfer him to the Connecticut Hospital for the Insane at Middletown, until the time of his trial. Any superior court, criminal court of common pleas, city court, or police court, before whom any person is tried on criminal charge) and acquitted on the ground of insanity, may order him to be con- fined in the Connecticut Hospital for the Insane for such time as the court shall direct, unless some person undertakes under bond to the state to confine him in such manner as the court may order. 37 CONNECTICUT Any person tried on any criminal charge who has been acquitted j^ 1 *** 6 of on the ground of insanity or dementia, and confined in the Con- itted necticut Hospital for the Insane, may petition, or the officers of institution may petition, the superior court of the county in which he is confined for his discharge. The petition must be served like civil process on the selectmen of the town to which he belongs, and upon the person, if any, upon whom the offense was charged to have been committed, and upon the state's attorney of the county in which the trial was had. The state's attorney must represent the state on the application. When a person, tried on any criminal charge and acquitted on * e the ground of insanity, has been confined in a hospital for the insane ac q ui ^ed. for a specified term, and is found still to be suffering from insanity at the expiration of the term, the superintendent of the hospital must certify the facts to the state's attorney for the county wherein the trial was had, who must procure from the court an order for the confinement of the person in the hospital until his recovery. When in the opinion of the jailer of any common jail, a prisoner gjj| ers in appears to be insane, he must immediately report the fact to the 278 *- governor, who shall appoint a commission of not more than three experts to examine the prisoner. If the commission find the prisoner insane, the governor, having approved its report, must order him committed to the Connecticut Hospital for the Insane until the expiration of the term for which he was committed, or until he has recovered from his insanity. If the prisoner has recovered his reason before the expiration of the term for which he was com- mitted, the superintendent of the hospital must report the fact to the governor, who shall appoint a commission to examine into his sanity; and if he has ceased to be insane, the governor must order his return to the jail. When a convict, transferred from a county jail to the Connecticut 378 * Hospital for the Insane, is confined as insane, at the time of the expiration of the term of imprisonment for which he was com- mitted the superintendent must certify the facts to the governor, who may order the detention of the person until he has recovered from his insanity. A male convict in the state prison becoming insane is cared for in the insane ward of the prison; a female, on certification by the physician and consulting physician of the prison, is reported to the governor, who orders her removed to a state hospital. When an insane male convict has finished his sentence, he is discharged from the prison into the custody of the Connecticut Prison Asso- ciation, which arranges for the prisoner's commitment to the state hospital, if in its judgment further confinement is necessary. 38 Board of supervisors of state institutions. Revised code. 1003. zoos. Board of trustees. 2593- 2603. DELAWARE Authorities : Revised Code of Delaware, 1915- Laws of 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of supervisors of state institutions con- sists of the governor and two residents of the state who are appointed and removed by the governor. They serve for four years and receive $100 per annum for expenses. The supervisors must visit at least once in three months all the state and other institutions within the state to which the state appropriates money and may investigate all matters relating to the conduct of the institutions and make any suggestions or changes in the control of patients as they may deem proper and necessary. Any complaint of cruel, barbarous, or unfair treatment made by an inmate of an institution wherein persons are deprived of their liberty must be fully investi- gated and if it is well founded, the board must prepare and present the person's charges against the one at fault to the board of manag- ers or the trustees of the institution. The supervisors must examine carefully into the financial arrangements of the institutions, the pur- chase of supplies, and disposition of funds, and make recommenda- tions to boards of trustees or managers. They must submit a statement to the governor at any time on his request and a full report biennially to the legislature. b. Institutional. The state hospital for the insane is under the management of a board of trustees of nine members, three from each county, who are appointed by the governor for terms of three years. One trustee from each county must be a physician in good standing. More than one political faith must be represented from each county. The board of trustees has sole and complete control and man- agement of the Delaware state hospital at Farnhurst, appoints physicians, stewards, matrons, nurses and all other necessary serv- ants, and fixes their terms of service as well as their pay; provides suitable food, raiment, medicine and all other things necessary for the comfort and improvement of the hospital. Each member receives a fee and compensation 'for attending board meetings. The board 'is prohibited from doing or contracting for any construc- tion or erection of buildings. 39 DELAWARE 2. CARE a. In state institutions. Delaware State Hospital, Farnhurst; established 1889; 500 beds. There are separate wards for white and colored patients. b. In local institutions. 3. COMMITMENT a. Persons committed. All indigent insane persons must be a 59 8 - admitted to the hospital upon the written order of one of the board of trustees. The board of trustees may also receive insane patients 26cl - from other states who are able to pay for their maintenance and support. Insane who are residents of the state may be received as pay-patients. The commitment of any person does not raise any presumption against his sanity. b. Legal procedure in commitment. Before a patient can be L** 8 of wn, received at the hospital a certificate must be filed with the superin- tendent, made and sworn to by at least two physicians, residents of AdmiMion by this state, who have been actively engaged in practice in the same certificate, state and county as that in which alleged insane "person resides. The certificate must state that the physicians have separately examined the person, that they believe that his disease requires hospital care and treatment; and that they are in no way related by blood to or connected by marriage with him, nor in any way connected with the hospital. The commitment papers of any in- mate of the New Castle county almshouse must be signed by at least one of the physicians required by law to examine patients committed from the city of Wilmington. The certificate must be made within one week after the examination of the person, and within two weeks of the time of the application for admission to the hospital. The certificate must be signed by the physicians and the signatures must be certified as genuine by an officer authorized to administer oaths, before whom the physicians must make an affi- davit as to the truthfulness of the facts. In all cases, the certificate and other papers must be accompanied by an order of admission, signed by one or more of the trustees of said hospital. Commit- ments to the hospital made by the chancellor, or any court of state, as provided by law, are exempt from the above provisions. The state board of trustees of the state hospital are required to appoint two physicians, of different schools of medicine, residing in Revised cod the city of Wilmington, for a term of three years. No person may be admitted to the state hospital upon the certificate of any physician living in the city of Wilmington, unless it is signed by at least one of the physicians appointed by the state board of trustees. Other- DELAWARE 40 Application for trial. 2603. Jury trial. 2600. 2602. 2603. 2601. wise, the admission of patients to the statfe hospital is in con- formity with the preceding paragraph. c. Voluntary admission. d. Appeal from commitment. A person committed to the state hospital or any person related to the person committed within the third degree of consanguinity or any other three persons may present a sworn petition to the chancellor at any time stating that they believe him to be sane and asking for a writ to the sheriff of the county to determine whether he is a sane or an insane person. The chancellor must then issue a writ de lunatico inquerendo to the sheriff, commanding him within five days after the service to sum- mon a jury to determine the case, and return the findings by the jury to the chancellor within two days. If the jury finds the person sane, the sheriff must send an order to the superintendent of the hospital for the release of the person. e. Cost of commitment. The expenses of the examination of an indigent insane person and of his removal to the state hospital must be paid by the county of which he is a resident. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent has authority to discharge an indigent patient who has recovered or who no longer needs residence in the hospital, provided he notifies the trustees of the popr of the county from which the person was committed of his intention. Without regard to the length of time a person has been com- mitted, a patient may be discharged as provided under 3. d., "Appeal from commitment." 7. COST OF MAINTENANCE Indigent insane are supported at the cost of the state. When an insane .person is able to support himself, the state board of trustees has authority to collect the necessary money out of his property, after reasonable provision is made for the maintenance and education of his family. The expense of caring for a criminal insane person is paid by the trustees of the poor of the county of his residence or in which the criminal act was committed. The board of trustees may make contracts in relation to the board and maintenance, care and custody of any insane resident of the state, and may recover from the person contracted with, or from the patient himself, the compensation agreed upon, or a reasonable compensation. , 41 DELAWARE 8. CRIMINAL INSANE If, at the trial of a person on an indictment, the defense of in- ^ r jfie f person sanity is established to the satisfaction of the jury, it must return a SSStment. verdict of "not guilty by reason of insanity." The court may there- 26 6 * upon order the person committed to the state hospital. The ex- penses of the removal of such insane person, and of his support at the hospital or institution, must be paid by the trustees of the poor of the county where the act charged was committed, or of the county of the insane person's residence. The court of general sessions may order an insane person, acquitted as above, set at large if satis- fied that the public safety will not be endangered, or may order his removal from any hospital to the almshouse of the county where he resided at the time of the commission of the act charged, or county where the act was committed. If in a capital case the prisoner becomes insane after conviction and before sentence, the court has power to appoint a commission, 26 7 - two at least of whom shall be practicing physicians, to inquire into the mental condition of the prisoner and make a report to the court. If the commission find the prisoner insane, he must be remanded to the custody of the sheriff until the further order of the court. Should he recover his reason after such remand, he must receive the sentence appointed for his crime. Whether the prisoner has re- covered his reason may be established to the court by any evidence it may choose to consider for that purpose, and need not be by commission. 42 Board of visitors. Code. 4840. 4842. Superintend- nt. 4839. 4838. 4843- DISTRICT OF COLUMBIA Authorities : Revised Statutes of the United States Code of Laws for the District of Columbia, 1911 i. ADMINISTRATION AND SUPERVISION a. General. The board of charities of the district of Columbia has power, under the order of the district commissioners, to in- vestigate and report upon the government hospital for the insane in common with other charitable institutions of the district. b. Institutional. Nine citizens of the district, appointed by the President, constitute the board of visitors of the hospital. The board of visitors, whose members serve without compensation, may, subject to the approval of the secretary of the interior, make any needful by-laws concerning the superintendent, his employees, and the patients. The board is required to visit the hospital at stated periods, exercises a careful supervision over its expenditures, and makes an annual report to the secretary of the interior. The superintendent of the hospital is appointed by the secretary of the interior. 2. CARE a. In federal institutions. St. Elizabeth's Hospital, Washington (Anacostia); established 1855; 3,000 beds. b. In local institutions. There are no institutions for the insane maintained by the district. The Washington asylum hospital has a psychopathic ward. 3. COMMITMENT a. Persons committed. 1. Insane persons belonging to the army, navy, marine corps, and revenue-cutter service; 2. Civilians employed in the quartermaster's pay and subsistence department of the army; 3. Men who while in the service of the United States in the army, navy or marine corps, have been admitted to the hospital and subsequently discharged, but who within three years after such discharge become insane from causes existing at the time of such discharge, and have no adequate means of support; 4. Indigent persons who have been in either of the services mentioned and discharged therefrom on account of disability arising from insanity; 5. Indigent persons who become insane within three years after their discharge from such service from causes which arose during and were produced by the service; 43 DISTRICT OF COLUMBIA 6. Inmates of the national soldiers' home; 32 Rev. stat., 7. All persons who having been charged with offenses against the 4852. United States are in the custody of its officers, and all persons who shall have been convicted of any offense in any court in the district .and imprisoned in any state prison or penitentiary, and who during their term of imprisonment have become insane; 8. Insane criminals and persons charged with crime in the courts 4851. of the district; 9. Indigent insane who are residents of the district (non-residents 4844- of the same class are admitted only for temporary care) ; 10. Beneficiaries of the United States public health service; 11. Private pay patients from the district who may be received 4853. at the hospital whenever there are vacancies. b. Legal procedure in commitment. Proceedings are instituted gJJ ?-^ upon petition of the commissioners of the district to determine the mental condition of alleged indigent insane residents of the district and persons alleged to be insane with homicidal or otherwise dan- gerous tendencies. All writs de lunatico inquirendo issue from the equity court, and the justice holding such court presides at all inquisitions of lunacy, and when necessary may call a jury from either the circuit or the criminal court, or may summon a special jury for such inquisitions. An insane person within the district may be apprehended and j^ 6 * 61 ^" 11 restrained without warrant by any member of the metropolitan 33 stat., 316. police or any other official in the district authorized to make arrests. He must at once file an affidavit with the superintendent of the metropolitan police that he believes the person in question to be insane, incapable of taking care of himself and his property, and dangerous to the public. Some near relative or friend of the person in the district must immediately be notified. The superintendent of the metropolitan police is authorized to 2> order the apprehension and detention without warrant of any indigent person alleged to be insane or who has homicidal or dan- gerous tendencies and found elsewhere than in public places, upon the affidavits of two or more responsible residents, which must state that they believe the person to be insane, the length of time they have known him, and that they believe him to be incapable of managing his own affairs and dangerous to the public, if allowed to go at liberty. But before the apprehension 'is ordered, the super- Eraminati011 - intendent of the metropolitan police must require the certificate of at least two physicians who shall certify that they have examined the person alleged to be insane and that he should not be allowed to remain at liberty, and that he is a fit subject for treatment. DISTRICT OF COLUMBIA 44 Appointment of guardian. Code, lisa. tiSb. The commissioners of the district are authorized to place in the government hospital for the insane for a period not exceeding thirty days*, indigent persons alleged to be insane residents of or found within the district, and alleged insane persons of homicidal or other- wise dangerous tendencies apprehended and restrained as provided above, pending their formal commitment to the hospital or their transportation to their homes when their places of residence are ascertained. The commissioners may, pending their temporary com- mitment or formal commitment to the government or to any other hospital for the insane, authorize the temporary commitment of the above named insane persons for a period not exceeding thirty days to any other hospital in the district, which in the judgment of the health officer of the district is properly equipped for the care of suck persons. Such a person may be detained in any police station or house of detention pending arrangements for his temporary deten- tion in the government hospital or other institution; or they may be detained there until formally committed, in case no other provi- sions are feasible. No certificate as to the sanity or insanity of any person is valid if made by a physician who has not been regularly licensed to practice medicine in the district, unless he be a commissioned surgeon of the United States navy, army, or public health service; or by a physician who is not a permanent resident of the district; or by a physician who has not been actually engaged in the practice of his profession for at least three years; or by a physician who is related by blood or marriage to the person whose mental condition is in question; or if made by a physician who is financially interested in the hospital in which the alleged insane person is to be confined, or who is officially connected with it. The penalty of a fine of not more than $500, or imprisonment for not more than three years, or both, is provided for making an affidavit without proper cause for the purpose of securing the detention or restraint of any person in the district or for knowingly making a false certificate. In case any person adjudged to be of unsound mind has property, real or personal, the equity court has full power to appoint a com- mittee or trustee of the person and of his estate, who must reimburse the district out of the funds of the person for all costs expended or incurred by it, both before and after the time of such appoint- ment. The equity court has full power to superintend and direct the affairs of persons non compos mentis, and to appoint a committee or trustees for such persons after hearing their nearest relatives, if residing within the jurisdiction of the court, and to make such orders for the care of their persons and the management and preservation 45 DISTRICT OF COLUMBIA of their estates, including the collection, sale, exchange, and rein- vestment of their personal estate, as to the court may seem proper. The commissioners of the district must, as soon as practicable, Jfgg^ *^; return to their places of residence or to their friends all indigent insane persons not residing in the district at the time they became insane who are detained in the government hospital for the insane, or who are committed to it temporarily. All necessary expenses incurred by the commissioners in ascertaining the residence of such persons or of their friends, and in returning them, are paid by the district. c. Voluntary admission. d. Appeal from commitment. Any person restrained of his law- ^ > e ea I s I rpus> ful liberty within the district, under any pretence whatever, or any person in his behalf, may apply by petition to the circuit court of the district for a writ of habeas corpus, to have, the cause of the restraint inquired into. e. Cost of commitment. All expenses incurred by the commit- l8 7 8 - ment of an insane person are chargeable to the district unless the 4848. person has &n estate, in which case he is liable for them. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Authority to discharge patients is vested in the superintendent. jj JJJJglJ!? When a patient committed to the government hospital for the in- undent, sane, or any other institution, recovers his reason and is discharged as cured, the superintendent of the government hospital for the insane, or the official in charge of any such other institution where such person has been under treatment, must immediately file with the clerk of the supreme court of the district his sworn statement that the person, in his opinion, was at the time of his discharge of sound mind, and this statement shall be sufficient to authorize the court to pass an order declaring the person restored to his former legal status as a person of sound mind. If the superintendent of the government hospital for the insane, in g^2S by the case of commitment to it, or if two or more physicians in regular policemen,' or attendance at any other hospital to which a person has been com- mitted for temporary care, or if two or more persons in the police or fire departments when a person is detained at the police station, certify in writing to the physicians of the hospitals in the district, that the person is not insane or has recovered his reason, the officials in question must at once discharge the alleged insane person and report their action to the commissioners of the district. DISTRICT OF COLUMBIA 46 ^ d st g a e t n , tS 395- Persons ac- quitted. Code, 927. Persons convicted. 7. COST OF MAINTENANCE One-half of the cost of support in the hospital of indigent insane from the district is paid out of the revenues of the district and the other half from the treasury of the United States. Patients from the army, navy, marine corps, etc., are supported wholly at federal expense. AcTo1 n i d 9iT ts ' The district P a y g to the federal hospital the entire cost of all dis- trict non-indigent civilian patients, and then seeks reimbursement in whole or in part from their personal estate or from the immediate family or friends of the patient. 8. CRIMINAL INSANE When a person tried upon an indictment or information is ac- quitted on the sole ground that he was insane at the time of the offense, the jury must so state in their verdict. When a person i& indicted or charged by an information for an offense, and before trial or after a verdict of guilty, prima facie evidence is submitted that the accused is insane, the court may summon a jury to make inquiry into the insanity of the accused in the presence and under the direc- tion of the court. If the jury finds the accused insane, or if he is ac- quitted solely on the ground of insanity, the court may certify the fact to the secertary of the interior, who may order him confined in the hospital for the insane, the person and his estate being charge- able with his support in the hospital. The person whose sanity is in question is entitled to a bill of exceptions and an appeal as in other cases. Any person becoming insane while undergoing sentence of any court of the district for crime may be committed to the hospital for the insane, by order of the secretary of the interior, to receive the same treatment as other patients during the continuance of his disorder. When a person confined in the hospital for the insane, who is charged with crime and subject to be tried or undergo sentence, is restored to sanity, the superintendent of the hospital must give notice to the justice holding the criminal court and deliver him to the court. Insane convicts. 928. Restoration. 939- 47 FLORIDA Authorities: Constitution of the State of Florida Compiled Laws of Florida, 1914 i. ADMINISTRATION AND SUPERVISION a. General. The board of commissioners of state institutions, consisting of the governor and the six administrative officers of the j^/tlt executive department, all elected by the people every four years, has complete control and management of the state hospital forLaws" led the insane, state penal institution, reform schools for boys and for Il88> girls, blind, deaf and dumb institute, and supervises the county chain gangs. A secretary is appointed by the board but he is not a member of it. The board employs the superintendent, physicians, medical superintend- attendants and other persons necessary for the proper management II89 ' and care of the insane, and of the hospital and the properties belong- ing to it; it prescribes the powers and duties of the superintendent II$)0 - and of all the other employees, and requires of the superintendent a bond with sureties. There is a state board of control, but it has no jurisdiction over the state insane hospital, its supervision being only over the state educational institutions. b. Institutional. There are no local boards of trustees. 2. CARE a. In state institutions. Florida Hospital for the Insane, Chattahoochee; established, 1877; 1,500 beds. There are separate accommodations for white and negro patients. b. In local institutions. Incurable, harmless, and indigent in- sane may be cared for in almshouses by the county commissioners, who are the overseers of the poor. The law provides that all indigent insane persons not requiring mechanical restraint shall be 1203. cared for as paupers by the counties, or the judge may commit them to any responsible person who offers to give them care and custody, without expense to the state or county; nevertheless, practically all classes are sent to the state hospital. 3. COMMITMENT a. Persons committed. The destitute insane other than the Destitute incurable and harmless are cared for and treated at the state hospital "5. for the insane. But the judge may in his discretion direct the insane LORIDA 48 person to be delivered to any other person for his care, custody and maintenance. 1196. The superintendent of the state hospital, when directed by the board of commissioners of state institutions, may receive any lunatic, idiot or insane person whose friends, parents or guardians are able 1198. and willing to pay for his care, custody and maintenance. In all such cases, the board of commissioners of state institutions prescribes the amount to be paid. etition. b. Legal procedure in commitment. When a resident of the state is supposed to be insane, either non compos mentis or sufficiently devoid of reason to be incapable of self-control, a petition signed by five reputable citizens, not more than one of whom may be a relative of the person, stating their belief that he is insane, and asking that a legal examination be made, may be presented to the county judge or ramming judge of the circuit court having jurisdiction. The county judge or 1201. ' judge of the circuit court to whom the petition is submitted must without unnecessary delay appoint as an examining committee one intelligent citizen, who is not a petitioner in the case, and two practicing physicians of good professional standing who are gradu- ates of a school of medicine recognized by the American Medical Association, when such physicians reside in the county. This com- mittee must secure the presence of the supposed insane person, and make a thorough examination to ascertain his mental and physical condition, and if considered insane, whether the insanity is acute or chronic, its apparent cause, the hallucination, if any, and the age and propensities of the subject, also whether he is indigent or possessing available means for his support. If the person alleged to be insane any time prior to the rendering of the decree in the case, applies to the court for permission to contest the charge of insanity, the court must appoint a hearing. If the accused is indigent and unable to procure the attendance of witnesses in his behalf, the court must summon a reasonable number of witnesses for him at the expense of the county. 'pjoa' The examining committee must report its findings to the county judge or judge of the circuit -court, and furnish the information called for in the preceding section, each of the three committeemen signing the report. *nmhment. Qn receiving the report of the examining committee, the county judge or judge of the circuit court, if satisfied that the person is in- sane, must order the sheriff of the county from which the report is submitted to deliver at once 'the person adjudged insane to the superintendent of the hospital for indigent insane. The order of commitment must include a copy of the information and report by 49 FLORIDA the committee and be transmitted by the sheriff to the superintend- ent of the hospital. When the report of the examining committee shows that the " 8 for alleged insanity is chronic, or produced by epilepsy or senility, and ms *- that the person does not require confinement or mechanical restraint to prevent self-injury or violence to others, but that he is indigent, the judge must find him incurably insane, harmless and indigent, and order the sheriff to deliver him to the county commissioners of the county where he resides for care and maintenance as by law provided for paupers. But if any responsible person will offer to assume the care and custody of any such harmless person without cost to the state or county, the judge or court may in his discretion so order. c. Voluntary admission. d. Appeal from commitment. Any person detained in custod may, by himself or by some other person, prosecute a writ of habeas corpus. e. Cost of commitment. All costs of commitment are paid by the county unless the patient has sufficient estate, in which case he is liable. 4. CONVEYING PATIENTS TO THE HOSPITAL The superintendent of the hospital must send a nurse or some Ilo s. suitable person to transport a committed patient to the hospital. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Patients regarded as sufficiently harmless may be sent home on Parole. furlough by the superintendent of the state hospital, provided that relatives or other persons are willing to sign an agreement guarantee- ing transportation, maintenance and medical care at home, and, if further hospital treatment should be necessary, the return of the patient to the hospital without expense to the state or county. Nonresident patients are formally discharged by the superintend- Discharge. ent and returned to their state of residence, accompanied by an at- tendant, the board of commissioners authorizing the return at the expense of the state. Patients deemed ready for discharge are examined by the super- intendent and staff of the hospital. When discharged, an indigent patient is given transportation to the place from which he was com- mitted, or to an equivalent distance elsewhere; pay patients are not given return transportation. 7. COST OF MAINTENANCE The destitute insane are maintained at the expense of the state. "9s- FLORIDA 50 Persons acquitted of crime. 3992. convicts 4134- 8. CRIMINAL INSANE When a person tried for an offense is acquitted by the jury on account of insanity, the jury, in giving their verdict of not guilty, shall state that it was given for such cause, and, if the discharge or going at large of such insane person is considered by the court man- ifestly dangerous, it musirorder him to be committed to jail or other- wise to be cared for as an insane person, or may give him into the care of his friends, on their giving satisfactory security for his proper care and protection; otherwise, he shall be discharged. The prison physician directs the removal of insane convicts to the prison hospital when it can be done without danger or detriment to the other inmates of the prison. LU DC S Ui LI O Ul 51 GEORGIA Authority : Park's Annotated Code of Georgia, 1914 i. ADMINISTRATION AND SUPERVISION a. General. There is no state board in Georgia having general supervision or control of charitable institutions. b. Institutional. The state hospital for the insane (State Sanita- g s e tees - rium) is under the management of ten trustees, appointed biennially T 57i- by the governor. They receive salaries not to exceed $150 per annum. The trustees have authority to prescribe all rules and regulations for the management of the institution, to appoint a i s?a. superintendent, who must be a skillful physician, and all the officers, J S73. to fix their salaries, and to remove any officer for proper cause. The trustees prescribe rules and regulations also in regard to the T S74. admission arid discharge of insane, epileptics, idiots, and demented inebriates. A department for insane convicts is to be established on the so- called "State Farm" at Milledgeville, under the control and manage- ment of the prison commission, but no appropriation has been made. 2. CARE a. In state institutions. Georgia State Sanitarium, Milledgeville; established 1842; 3,800 beds. The statutes require white and negro patients to be cared for in separate departments; likewise, residents, nonresidents, and con- victs. b. In local institutions. Harmless incurable insane may be cared w8. for in the county poorhouses or otherwise taken care of by the county authorities. The poor farms are under the management of the or- dinary of each county, who may appoint a commissioner of the poor. 3. COMMITMENT a. Persons committed. All resident citizens of the state who are insane, idiots, epileptics or demented inebriates may be ad- R^ents. mitted, but the superintendent may refuse all harmless idiots and T S97- other harmless subjects that do not actually require treatment so X S99- long as there are any recent and dangerous cases unprovided for. Nonresident pay patients may be received, but citizens of Georgia Nonresidents, have the preference when all can not be accommodated and are treated free; no nonresident patients have been admitted for nearly fifty years. GEORGIA 52 Trial by jury. Pay patients. 1601. 1603- 1609. Insane negroes. 1611. ition as to need of guardian. 3092. Commitment by guardian. 3100. Commitment by court. 3101. b. Legal procedure in commitment. The various laws concerning commitment have been so construed that in practice no patient, white or negro, is admitted to the state hospital without trial by jury. A pay patient, restrained in the state, may not be admitted unless accompanied by authentic evidence of insanity, or a certificate of three reputable practicing physicians, well acquainted with his condition, or from one such physician and two respectable citizens. A pay patient, not a resident of the state, may not be admitted unless producing an authentic record of a conviction by a competent court of a malady which, according to the law of the state, is a ground of admission, or a certificate of physicians endorsed by the judge having jurisdiction. Before or after admission of a pay patient, resident or nonresident, by certificate, the person alleged to be insane, or his friend or relative, may demand a trial of the question of insanity by jury, which must be had in the county of Baldwin. In practice, no patients have been required to pay for their maintenance for nearly fifty years. The certificate of the ordinary of the county where an insane negro resides, of his condition, mental and pecuniary, is sufficient to grant his admission to the hospital. On the sworn petition of any person that another is liable to have a guardian appointed (or is subject to be committed to the state sanitarium), the ordinary after notice has been given to the three nearest adult relatives of such person must issue a commission directed to any eighteen discreet and proper persons, one of whom shall be a physician, requiring any twelve of them, including the physician, to examine the person for whom guardianship (or com- mitment to the sanitarium) is sought. But in all insanity cases the number of jurors is six, one of whom must be a physician, unless twelve are demanded by the person tried, or by his relatives or friends. The commission must find whether the person is to have a guardian appointed or to be committed to the state sanitarium, and make return to the ordinary, who must act accordingly. Guardians of insane persons may place them in the Georgia State Sanitarium, if such a course is necessary for their own protec- tion or the safety of others, and a guardian wilfully failing to take this precaution is responsible for injuries inflicted on others by his ward. When there is no guardian for an insane person, or the guardian refuses or fails to confine his ward, and any person makes oath that the insane person should not longer be left at large, the ordinary or the judge of the superior court must issue a warrant as in criminal cases for the arrest of the insane person and after an investigation of 53 GEORGIA the facts may commit him to the state sanitarium, and may have him committed to jail until he can be removed to the sanitarium. A patient who is absent for as long as three months, either by Recommitment, discharge, elopement, or removal by friends, can not be received at the sanitarium without going through the process required by law. c. Voluntary admission. When an application for admission is l612 - unattended by the requisite evidences, the superintendent of the sanitarium may receive and provide for the person for a reasonable time, provided a sufficient sum is advanced for his maintenance. The trustees of the hospital require, however, that no patient shall be admitted unless all legal requirements have been complied with. d. Appeal from commitment. A trial by jury may be had by all Tr j^ jury - patients who have been convicted of insanity, if a relative or friend will make an affidavit that he believes the alleged cause of commit- ment did not and does not exist, and that the conviction was ob- tained by fraud, collusion or mistake. The same right exists, when there is an affidavit that the cause of commitment has ceased to exist, and there is a refusal by the superintendent to discharge after demand made. e. Cost of commitment. The expense of a commission in insanity must be paid out of the estate of the insane person; and if he has none, out of the county funds. The cost of conveying a person to 394- the state sanitarium is paid in the same manner. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Upon recovery, patients must be discharged by the superintend- 1574> ent under rules prescribed by the trustees. Upon the certificate of the medical officer of the institution, the I578 - trustees may discharge or remand to the authorities of the county from which he was sent a patient whose condition is such that no probability exists of his full recovery, and who at the time is regarded as harmless. 7. COST OF MAINTENANCE The state sanitarium is free to all resident citizens of the state I ^ 6 - who are insane, idiots, or epileptics. If the family or friends desire to furnish extra or additional food or other comforts, they may do so . under regulations prescribed by the trustees. 8. CRIMINAL INSANE When a person has been guilty of a capital crime and acquitted on the ground of insanity and is committed to the sanitarium, he must not be discharged except by special act of the legislature. If the GEORGIA 54 crime is not capital, he may be discharged by warrant or order from the governor. If sentence is suspended on the ground of insanity, the superintendent upon his restoration to sanity must certify the fact to the presiding judge of the court where he was convicted, insane convicts. ^ convict sentenced to the penitentiary who becomes insane must be removed to and kept at the prison farm during the term for which he may have been sentenced, or until he is cured. (This provision is not yet operative.) 55 IDAHO Authorities: Revised Codes of Idaho, 1908 Laws of 1915 i. ADMINISTRATION AND SUPERVISION a. General. There is no state administrative or supervisory board of charitable institutions. b. Institutional. The state hospitals are under the management Board ofi and control of boards of directors, consisting of three persons, ap- Revised code pointed by the governor for terms of two years in the case of one 752- institution, and three years in the case of the other. Each board elects a medical superintendent of the hospital, to hold office during its pleasure. It appoints all officers and employees, prescribes their duties and may remove them when in its judgment the good of the 753- public service so requires; it makes regulations and fixes the terms for the admission of insane persons who are not indigent or who are not residents of the state. The board must visit the hospitals once in three months. The board is required to make an annual report to the governor and a biennial report to the legislature concerning all matters that pertain to the hospital. The medical superintendent must be a graduate in medicine and Superintend- must have practiced his profession five years. With the consent of 737. the board of directors, he fixes the number and compensation of and 759- removes the attendants and assistants. 2. CARE. a. In state institutions. The Idaho Insane Asylum, Blackfoot; established, 1884; 350 beds. Northern Idaho Sanitarium, Orofino; established, 1905; 250 beds. b. In local institutions. The county poorhouse where such exists may care for insane persons placed therein by the board of county commissioners. 3. COMMITMENT a. Persons committed. All insane persons except idiots, feeble- 76 ?- minded and those suffering from delirium tremens or a contagious or 780. infectious disease, may be admitted to the hospitals. No insane nonresident may be received into the hospitals unless ? 68 - he became insane within the state, and the indigent insane of the state must have the preference. b. Legal procedure in commitment. Whenever it appears by Affld * vit - affidavit to the satisfaction of a magistrate of the county that any IDAHO 56 Certificate of physician. 775. Order of commitment. 777- Habeas corpus. 781. 782. Inquir * uiry by the Agent of the superintend- ent. 778. 781. person within the county is so far disordered in his mind as to endanger health, persons or property, he must cause such person ta be arrested and taken before any judge of a court of record within the county for examination. The two or more witnesses best ac- quainted with such insane person and at least one graduate of medicine must testify _at the examination. If the physician after hearing the testimony and making the examination believes such person to be dangerously insane, he must make a certificate in the form prescribed by the medical superintend- ent of the hospital, showing that such person is so far disordered in his mind as to endanger health, person or property; the premonitory symptoms, apparent cause or class of insanity, the duration and con- dition of the disease, etc. The judge after such examination and certificate, if he believes the person so far disordered in his mind as to endanger health, person or property, must make an order that he be confined in a state hospital. c. Voluntary admission. d. Appeal from commitment. Upon petition on behalf of any person restrained of his liberty, the writ of habeas corpus may be granted by the circuit court or by the district court. e. Cost of commitment. .The expenses of the agent, his necessary assistant, and of the insane person when transferred to the hospital,, are paid by the hospital. The physician attending the examination of an insane person is paid by the treasurer of the county where the examination was had. The judge must inquire into the ability of an insane person com- mitted by him to the hospital to pay for his transportation to the hospital, and the expense of the examination, and bear the actual charges and expenses for the time that such person may remain in the hospital. In case an insane person committed to the hospital is possessed of real or personal property sufficient to pay such charges and expenses, the judge must 'appoint a guardian for him, who must pay to the board of directors the sum fixed upon by them each month quarterly in advance, for the maintenance and clothing of such ward. 4. CONVEYING PATIENTS TO THE HOSPITAL An insane person, ordered to be committed, must be delivered to the sheriff of the county and by him to the agent appointed by the medical superintendent to convey the insane person to the hospital. Upon receipt of notice from the sheriff, the medical superintendent must at once designate some person among the employees of the hospital as an agent to transport such insane person to the hospital. Such agent (and assistant if any be appointed), must at once convey 57 IDAHO the insane person to the hospital and surrender him to the medical superintendent ; and the latter shall at once notify the governor that the insane person has been received. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The board of directors may on the recommendation of the super- Parole. Laws of 1915. intendent parole patients who are not dangerously insane. Any 37- person aggrieved by the granting of such parole may appeal to the district court within thirty days and the court may affirm or modify the order. Insane persons received in the hospital must upon recovery be Re^ discharged therefrom. 765. 7. COST OF MAINTENANCE The expense of maintaining insane patients at the hospital is borne by the state unless the inmate has sufficient estate to pay it. 8. CRIMINAL INSANE Insane convicts must be received into the state hospital returned to the state prison when cured in case their sentence at the time of recovery has not expired. 58 ILLINOIS Authorities : Kurd's Revised Statutes of Illinois, 1915-1916 Civil Administrative Code of Illinois, 1917 i. ADMINISTRATION AND SUPERVISION ^tln^'weifare a * General. The executive arid administrative supervision of all cmi Mde. state institutions for the care of the insane is exercised by the S3- ' department of public welfare. The department has all the rights, powers, and duties formerly vested in the board of administration, state deportation agent, state agent for visitation of children, com- missioners and wardens of the state penitentiaries and reformatories, board of pardons, board of prison industries, and board of classifica- tion. The department is under the control of a director, who is appointed *j by the governor. He receives a salary of seven thousand dollars per |- year. In addition to the director, the governor appoints an as- , J|; sistant director, receiving a salary of $4,000, and the following execu- Ig - tive officers, all receiving salaries of $5,000: alienist, criminologist, fiscal supervisor, superintendent of charities, superintendent of prisons, and superintendent of pardons and paroles. All officers devote the entire time to their duties during the four-year term, and 2S - are bonded in not less than $10,000. The director reports annually to the governor and biennially to the general assembly. Scutes * n addition to succeeding to all rights and duties of the former JJ^s. board of administration so far as property rights are concerned, l8b the department of public welfare regulates the admission of patients to state hospitals; appoints and removes superintendents of these * Q) institutions, and, subject to the civil service law, appoints all em- * ( J) ployees and fixes their salaries ; investigates all private institutions for the insane, makes stated visits to the hospitals for the purpose of inspection and oversight; and holds meetings with the superin- tendents of hospitals and the board of public welfare commis- sioners to consider in detail all questions relating to the treatment and care of the insane. l8L Each managing officer of a hospital for the insane must develop occupations that serve the mental, moral and physical improve- ment, or the happiness of the inmates; and it is the duty of the department of public welfare to co-ordinate these activities as will best serve an educational economical and efficient administration of all the institutions. ?ubiic welfare Within the department there is a board of public welfare com- ciXo S de. ners ' missioners, composed of five officers serving without salary. The 59 ILLINOIS board is purely advisory and nonexecutive: its general powers and duties are to consider and study the field, to advise the executive 6 - officers of the department upon request, to recommend policies and 8 - practices, to give advice and make recommendations to the governor and general assembly, to investigate the conduct of the work of the department and for this purpose to have access to all books, docu- ments, papers, and records, and to require written or oral informa- tion from any officer or employee. The more specific duties of the board are to investigate the con- 54. dition and management of the whole system of state charitable, penal, and reformatory institutions, including state hospitals; when directed by the governor, to investigate and report to him con- cerning the equipment, management, or policy of any state char- itable, penal, or reformatory institution; to inquire into the equip- ment, management, and policies of all institutions and organizations coming under the supervision and inspection of the department of public welfare; to collect and publish annually statistics relating to insanity and crime. All other than state institutions giving treatment and care to^| ls persons suffering from mental and nervous diseases must provide the department of public welfare with detailed information from time to time, regarding their physical equipment and medical and nursing service, and furnish it a certified statement every three months, giving the admissions, deaths and discharges during the previous three months. The department must license such institu- tions as it deems suitably equipped and conducted, and no person may be committed to or received in any such institution not having a valid license from the department under a penalty of a fine from $50 to $1,000, or imprisonment for not more than six months, or both. b. Institutional. There are no local boards of trustees. 2. CARE a. In state institutions. Jacksonville State Hospital, Jacksonville; established 1847; 2,100 beds. Chicago State Hospital, Dunning; established 1860; 3,300 beds. Elgin State Hospital, Elgin; established 1869; 2,056 beds. Anna State Hospital, Anna; established 1869; 1,900 beds. Kankakee State Hospital, Kankakee; established 1877; 3,250 beds. Chester State Hospital, Menard; established 1889; 220 beds. (For the dangerous insane.) ILLINOIS 60 State care of insane. i8c Boarding out insane patients. Insane defined, ch. 85. Admission of non-residents 32. Private patients. 19. Watertown State Hospital, Watertown; established 1895; 1,660 beds. Peoria State Hospital, Peoria; established 1895; 2,300 beds. Alton State Hospital, Upper Alton; established 1913; 400 beds. The state psychopathic institute is located at Kankakee. b. In local institutions. Cook county maintains a psychopathic hospital (220 beds) as a department of the Cook county hospital. The department of public welfare is required to remove insane persons from county almshouses to state hospitals, the state having assumed complete care of its insane and feebleminded. c. In families. Any insane patient in any state hospital may be placed at board in a suitable family home by the department of public welfare. The cost of boarding out a patient may not exceed the average per capita cost of his maintenance in the hospital. Patients boarded out must be visited at least once in three months. A patient boarded out may be permitted by the department tempo- rarily to leave custody as an insane person in charge of his guardian, relatives, friends or by himself, for a period not exceeding one year, and may be received again when returned by guardian, relations or friends, or upon his own application, without any further order of commitment. During such temporary absence the department may assist in his maintenance to an amount not exceeding the rate paid for his board. 3. COMMITMENT a. Persons committed. All insane persons residents of the state, not idiots and epileptics, are entitled to admission to the hospitals for the insane. By insane is meant any person who by reason of unsoundness of mind is incapable of managing his own estate, or is dangerous to himself or others, if permitted to go at large, or is in such condition of mind or body as to be a fit subject for care and treatment in a hospital or asylum for the insane. No person, idiot from birth, or whose mental development was arrested by disease or physical injury occurring prior to the age of puberty, and no person who is afflicted with simple epilepsy is regarded as insane, unless tlje mani- festations of abnormal excitability, violence or homicidal or suicidal impulses are such as to render his confinement in a hospital or asylum for the insane a proper precaution. Insane persons not residents of the state may not be detained in any private institution for the insane unless committed in accordance with the laws of the state in which they are residents, or with the laws of Illinois. No private patient may be admitted to a state hospital for the insane until a bond with sureties has been filed with the superintend- 61 ILLINOIS ent, and approved by the county judge conditioned to provide suitably for him and to remove him when required. b. Legal procedure in commitment. No person not legally J^^- 1 * adjudged to be insane, may by reason of his insanity or supposed 2 - insanity be restrained of his liberty, except that the temporary detention of an alleged lunatic is permitted for a reasonable time, not exceeding ten days, pending a judicial investigation of his mental condition. Any reputable citizen of the county in which a person supposed to be insane resides or is found may file with the clerk of the county court a sworn statement that the person named is insane and re- quires restraint or commitment to some hospital for the insane. The statement must be accompanied by the names of the witnesses (one of whom at least must be a physician having personal knowl- edge of the case) . When the person alleged to be insane has not been Hearing, examined by a physician, the judge may appoint a qualified physi- cian of the county to make such examination. The hearing of the case may take place with or without the presence of the person affected as circumstances warrant, but not until he has been notified. Inquests in lunacy must be by jury or a commission of two licensed ^ e s r ts a b * om _ physicians. When no jury is demanded, and there appears to judge to be no occasion for it, he must appoint a commission of two qualified physicians in regular and active practice, who are residents of the county and of known competency and integrity, to make a personal examination of the patient and file with the clerk of the court a sworn report of the result of their inquiries, together with their conclusions and recommendations. The commissioners have power to administer oaths and take sworn testimony. In all cases 7 - of inquest by jury, the jury must consist of six persons, and one of the jurors at least must be a qualified physician. Inquests in 8 - lunacy may be in open court or in chambers, or at the home of the person alleged to be insane, at the discretion of the court. The judge may require all persons other than the patient, his friends, witnesses, licensed attorneys and officers of the court to withdraw from the room during the inquest. The jury or commission must furnish the court in writing answers J ury - to the interrogatories that may be prescribed by the department of public welfare, and certify to their correctness. The interrogatories must be submitted to the medical member or members of the jury or commission by the court. The court may, if not satisfied with the finding of the jury xo - or commission, set the same aside and order another inquest. Upon the return of the finding of the jury or commission, the Findin e- court must enter the proper order for the disposition of the person ILLINOIS 62 alleged to be insane, and order his discharge with or without condi- tions, or remand him to the custody of his friends, or" commit him to some hospital or asylum. K^e'into A * *kc time of each inquest in lunacy, the county judge must condition" of inquire into the pecuniary condition of the person alleged to be insane person. i nsa ne, and that of the relatives who are bound by law to maintain him. order of When the order of commitment has been entered, the clerk of the commitment. '7- county court must send copies of the papers in the case to the superintendent of the hospital who must admit the patient without delay. If there is no room or the hospital or the county has its full quota of patients, the superintendent must make room for a patient recently adjudged insane by returning a quiet, harmless- chronic insane to the county from which he was admitted or to a hospital for chronic insane. f r ^ a P erson alleged to be insane is possessed of any estate, the . person filing the application for an inquest in lunacy may make at the same time application for the appointment of a conservator of the alleged lunatic. If he is adjudged insane without application for a conservator having been made, and if he has any estate, the court may, upon petition, make an appointment of a conservator. In a county with a probate court, upon filing of the proper petition, together with the duly certified copy of the record and the verdict of the jury, or the report of the commission of physicians, and the judgment of the county court finding a person insane, the probate court may without further inquest appoint a conservator. Application. Ct Voluntary admission. Any person in the early stages of insanity who may desire the benefit of treatment in a state or licensed private hospital for the insane as a voluntary patient, may be admitted to it on his written application, accompanied by a certificate from the county court of the county in which he resides. All voluntary patients have the right to leave the hospital at any time on giving three days' notice to the superintendent. To^the circuit d. Appeal from commitment. Appeals are allowed to the circuit " court from any order or judgment made are rendered under the act governing commitments upon the appellant giving such bond and security as the court may direct. Habeas corpus. Every person confined as insane is entitled to the benefit of the writ of habeas corpus, and the question of insanity must be decided at a hearing. If the judge decides that the person is insane, this does not bar the issuance of the writ a second time or whenever it is al- leged that he has been restored to reason. If the person is adjudged sane, the court where the inquest was had must, on the presentation 63 ILLINOIS of a certified copy of the judgment, rescind the judgment of in- sanity. e. Cost of commitment. The costs of proceedings in inquests lunacy in case of county patients are paid from the county treasury of the county of which they are residents; but in case of private patients, if the person is found to be insane, they must be paid by his guardian or conservator out of his estate. When the person is found not to be insane, the court may require the costs to be paid by the person who filed the application for commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL The clerk must issue a warrant, in duplicate, directed to the Clerk 'f 81165 warrant. sheriff or any suitable person, giving preference to some relative l8 - of the insane person, when desired, to deliver the insane person to the superintendent. No female patient may be taken to the hospital by any person not her husband, father, brother, or son, without the attendance of some other female of reputable character and mature age. 5. TRANSFER OF PATIENTS The department of public welfare has power to transfer patients l8e> from one state hospital for the insane to another, when in its judg- ment transfers are advisable. 6. PAROLE AND DISCHARGE OF PATIENTS Under regulations of the department of public welfare, patients ^ n ^ e de P art ~ may be released on parole for any term not exceeding three months, and, if not returned to the institution within that period, a new order of commitment from the county judge is necessary for read- mission to the institution; but the court may make such order upon the old verdict, if satisfied that the patient in question is still in- sane. Subject to the rules of the department of public welfare, the By ^ tend _ superintendent of a hospital may discharge a patient because he is en *- 2> not insane, or because he has recovered, or because he is so far improved as to be capable of caring for himself, or because the friends of the patient request his discharge, and in the judgment of the superintendent no evil consequence is likely to follow such dis- charge, or because there is no prospect of further improvement under treatment. No patient who has not recovered his reason or who is charged with crime may be declared discharged until at least ten days after notice to the judge of the county court having jurisdic- tion in the case, in order to enable the judge to make proper order as to the disposition of the patient upon discharge. 64 A person discharged from a state hospital or asylum for the insan 6 must be provided with suitable clothing and a sum of money, not exceeding $20, sufficient to defray his expenses home, which are charged to the patient, if a private patient, and if a county patient, to the county. When notified that a patient has been discharged as cured, the judge of any county court must enter an order restoring the patient to all his rights as a citizen, and if a conservator of his estate has been appointed, the conservator must be removed. At any time subsequent to the discharge of any patient, the judge of the county court may hear evidence tending to show that the patient has been restored to reason, and if satisfied of his recovery may enter a similar order, whereupon the patient is not liable to commitment to a hospital without a new inquest in his case. A staff physician, or some other suitable person must, when the superintendent deems it necessary, visit the home of any paroled patient or any convalescent patient before discharge and advise with the family as to the care and occupation most favorable for the patient's continued improvement. Visits must be made from time to time to the patient after parole or discharge as are considered necessary by the superintendent. 7. COST OF MAINTENANCE All insane persons in the state hospitals are maintained at the expense of the state. When they are able to do so, relatives or estates of patients must furnish their clothing. 8. CRIMINAL INSANE Insane convicts in the state penitentiaries may be committed to the* asylum for insane criminals without formal inquest on the certificate of the penitentiary physician, and held until adjudged by the superintendent and the department of public welfare fit to be discharged. Where any person is sent to a state hospital for the insane, being acquitted of crime on the plea of insanity, or being under indictment for crime, the state's attorney in charge of the case must officially notify the superintendent of the hospital to which the accused is sent, of any indictment pending against such person, or of the fact that the accused has been acquitted of his crime on the plea of insanity, and the superintendent, in case he at any time discharges the accused, must officially notify the state's attorney of the fact of the discharge and the reasons therefor. 65 INDIANA Authorities: Burns' Annotated Indiana Statutes, 1914 Laws of Indiana, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of state charities is composed of governor of the state as ex-officio member and chairman and six uncompensated members three from each leading political party appointed by him for terms of three years. This board must in- vestigate and examine into the condition and management of hospitals, and the officers in charge of the hospitals must furnish to it all the information and statistics which it may require. At any 3666- time it may investigate the management of any correctional or charitable institution of the state, and must report the result of its investigation to the governor, who must submit it to the general assembly. The judge of the circuit court of any county may and upon thejjj^j *"* 1 * petition of fifteen citizens must appoint a board of county charities. 3675> These boards are composed of six unsalaried members not more than four of whom shall be men and shall be appointed for terms of three years. At least once each quarter and as much oftener as they think necessary, the board in each county must inspect the county poor asylums and any other charitable and correctional institutions in the county which receive public aid. It must make a quarterly report to the board of commissioners of the county of the condition of each institution, and must present annually a report of its work to the judge of the circuit court and to the board of state charities. It must report to the board of county commissioners and the board of state charities any facts in connection with an institution which ought to be known to the commissioners, especially anything in- jurious to the county or to the inmates of the institution and must suggest remedies for the evils reported. At any time the county board of charities may call upon the board of state charities for advice and assistance. The board of county commissioners has supervision of the county f^f y of asylum for the poor and of the county asylum for the incurably commissioners, insane in any county in which one has been established. These 9780. commissioners appoint the superintendent of the county asylum for a term of four years. Township trustees are ex-officio overseers of the poor and have ^e e p S e r rsof charge of indigent persons who are not provided for in public in- 74i- stitutions. 6 66 3438- 3439- 3440. 3451. 3442. 3741- 3746- 3738-3739- 3102. 978o. 3731- 3763- 376 4 . b. Institutional. Each of the general state hospitals for the in- sane is under the legal custody and supervision of a board of trus- tees composed of four compensated members not more than two of whpm can be from one political party. These trustees are appointed by the governor for four-year terms and are removable by him for cause after an opportunity to be heard upon written charges. Each board appoints as superintendent for the hospital under its charge a reputable physician who has had experience in an institution for the insane, and fixes the number of subordinate officers and employees and their compensation. The superintendent has personal charge and supervision of the institution and its in- mates and appoints all other officers and employees subject to the rules, regulations, orders, and general control of the board of trus- tees, to whom he must make his reports. The board meets at the hospital every month and must make an annual report to the gov- ernor. This report must be printed and transmitted by the gov- vernor to the general assembly with his annual message. The hospital for insane criminals at Michigan City is under the management of the board of trustees and warden of the state prison. The physician in charge must have had at least three years' practical experience as a physician. 2. CARE a. In state institutions. Central Indiana Hospital for the Insane, Indianapolis; established 1844; 1,434 beds. Northern Indiana Hospital for the Insane, Logansport; established 1883; 1,000 beds. Eastern Indiana Hospital for the Insane, Richmond; established 1883; 867 beds. Southern Indiana Hospital for the Insane, Evansville; established 1883; 870 beds. Southeastern Hospital for the Insane, North Madison; established 1905; 1,150 beds. Indiana Hospital for Insane Criminals, Michigan City; established 1909; 175 beds (for males only). The statutes require that male and female insane shall be treated in separate wards or departments. b. In local institutions. Each county provides in the county poor asylum for such of its indigent insane, especially incurably insane, as can not be received into the state hospitals. Counties of 150,000* or more population may provide a separate asylum for the care and treatment of incurably insane paupers. The board * Marion County City of Indianapolis. 67 INDIANA of county commissioners may contract with guardians for the treat- ment of the incurably insane of the county not paupers in these asylums at reasonable compensation. 3. COMMITMENT a. Persons committed. All insane persons, not idiots, residing |f; in the state who have legal settlement in any county therein are entitled to be maintained and to receive medical treatment in the 3736- state hospitals for the insane at the expense of the state. b. Legal procedure in commitment. Upon a statement in ^j*{te court writing to the probate court of any county, that an inhabitant of 3I01 - the county is of unsound mind and incapable of managing his own estate, the court shall cause an issue to be made out and hold a hearing to determine the sanity of the person. The hearing may be by the court with or without a jury, and it is the duty of the prose- cuting attorney to appear and protect the interests of the person alleged to be of unsound mind. If the person is found to be of unsound mind, the court must appoint a guardian to have the cus- tody of his person and the management of his estate. If the court 3 finds that the person is dangerously insane it must make such order for his safe-keeping as is necessary. An allegation that a person of unsound mind has become of sound mind may be tried and deter- mined in the same manner as an allegation of unsoundness of mind. Proceedings for committing an alleged insane person to a general ^t state hospital for the insane are by a sworn statement regarding his insanity by a citizen of the county filed with a justice of the peace and upon an examination and a hearing held by this justice and two reputable practicing physicians of the county selected by him, or by the circuit or superior court. At this hearing the justice may 3<5 94- examine witnesses against and in behalf of the person alleged to be Examination, insane, may summon medical examiners, and must obtain a certifi- cate of the medical attendant of the alleged insane person giving the 3697 - medical history of the case. The medical examiners must make a sworn statement of the results of their examination, declaring whether in their opinion the person under examination is insane or 3698. not, and the justice must deposit a sworn statement of his findings, 3699- and all the documents in the case, with the clerk of the county circuit court. If the person has been found insane the clerk of the Commitment, court must apply to the superintendent of the proper hospital for the admission of the insane person, accompanied by a certificate of a justice of the peace that such person has a legal settlement in the county in which settlement for him is claimed. Until he can be 3?"- received into the hospital, the clerk must direct how he shall be taken care of, and, if necessary, may order his confinement in the INDIANA Deportation of non-residents. Laws of 1917, ch. 56. Order of admission. Statutes. 3731- Arrest of dangerous 7879- Jury trial. Trial by circuit court. Commitment. 7887. Recommitmer 3733- county jail. The superintendent immediately must determine the nature of the case and whether the person can be received into the hospital. If the applicant does not have a legal settlement in the state, or if the place of settlement is in doubt, the superintendent must notify the board of state charities. The board must make an investiga- tion and may order the applicant committed or deported. The expense of deportation is paid by the state. Applicants for admission into the hospitals when they are crowded must be received in the following order: (1) recent cases, when the disease is of less than one year's duration, (2) chronic cases, more than one year's duration, presenting the most favorable prospects of recovery, (3) those for whom application has been longest on file. Superintendents are required to see that each county has a just proportion of its applicants accepted according to its population, but the trustees may give preference to recent cases from one county, over chronic cases from another. Rejected applications may be renewed by the proper county clerk by reference to the original application, and may be accepted by the superintendent, provided the renewal is made within six months of the inquest. A justice of the peace must issue a warrant to a constable or sheriff for the arrest of any person of whom complaint under oath has been made that he is dangerously insane. The justice must summon witnesses and a jury of disinterested householders, and determine the sanity of the person complained of as dangerously in- sane. If the jury finds that the person is dangerously insane the justice appoints some one to take charge of and confine the insane person at the expense of the county. The justice must certify his findings in the case to the circuit court of the county wherein a new hearing of the case must be had if the finding was against the insane person, or an appeal may be had by the complainant if the finding was in favor of the person charged with being dangerously insane. Upon verdict in the circuit court that the person is dangerously insane the court must appoint a guardian for him and approve the appointment of the custodian of his person made by the justice of the peace or appoint some other custodian. A person thus declared to be dangerously insane may at any time be committed to a hospital for the insane according to the usual procedure. Proceedings for the recommitment of a person once declared insane and committed to a hospital but afterwards discharged may be instituted upon the affidavit of a physician that the person was adjudged insane, was an inmate of a hospital, was discharged, but is again insane, and a proper subject for treatment in a hospital. A 69 INDIANA copy of this affidavit certified to by the county clerk and a certificaet from the clerk of the county circuit court of the record of the former adjudgment of insanity are transmitted to the superintendent of the proper hospital for the insane or to the friends of the patient and upon them as a basis an inquest into the mental state of the alleged insane person is made according to the procedure of an original inquest. c. Voluntary admission. d. Appeal from commitment. Appeal from commitment may be H *^2^ corpus, made on a writ of habeas corpus in behalf of any person committed as insane, and the question of insanity must be decided at the hearing. An adverse decision does not bar the issuance of another writ after three months have elapsed. e. Cost of commitment. A guardian appointed for a person of T 3 j ( * ardian> unsound mind must pay the expenses of the legal procedure out of the estate of his ward. If the person alleged to be of unsound mind is found to be of sound mind, the person who made the charge of insanity against him must pay the costs. The estate of a person of unsound mind must pay the costs of a proceeding brought for his release on the ground of recovery, if the proceedings are successful; if he is held still to be of unsound mind costs are taxed to the person filing the application for him. All expenses incident to commit- T 3 * 3 h 2 spitaL ments into a hospital for the insane are paid by the counties. If a person declared dangerously insane by a circuit court has J^ e e rous no family, the costs of proceedings, commitment, and maintenance ms *j; are paid out of his estate if he has any, and the costs of the pro- ceedings in the court of the justice of the peace are refunded to the county out of it; but if he has a family these expenses are borne by the county of which he is a legal resident unless his estate ex- ceeds in value $500. If on the trial in the circuitc ourt he is released, all these expenses are borne by the persons bringing the complaint of insanity against him. Fees and expenses of lunacy commissions are paid out of the state treasury. 4. CONVEYING PATIENTS TO THE HOSPITAL The county clerk upon receipt from the superintendent of the cierinssues acceptance of an application must issue a warrant to the sheriff 3706. or other suitable person to arrest and convey the person to the hos- pital. A female patient must be accompanied by a female at- 2193. tendant, unless accompanied by husband, father, or son. 5. TRANSFER OF PATIENTS An inmate of any state hospital who has not a legal settlement i a county of the district in which the hospital is situated may be 372 transferred to the hospital of his proper district by mutual agree- INDIANA 70 Laws of 1917, ch. 154. ment of the respective boards of trustees. By mutual agreement of the boards of trustees of any two hospitals for the insane, a patient may be transferred for any sufficient reason, not oftener, however, than once in five years. The governor may cause the transfer of any ward or inmate upon apetition being filed with him by the superintendent. 6. PAROLE AND DISCHARGE OF PATIENTS B y the A patient who has been restored to health must be discharged by statutes. ' the superintendent of the hospital for the insane to the sheriff of the county from which the patient was committed, to friends willing and able to care for him, or to himself if he is able to provide for 3725. himself. Discharge to a sheriff is to remove the patient to his home and is made upon order from the clerk of the county circuit court on notice to the clerk from the superintendent of the hospital. commissioners. ^ n inmate of a county asylum for the incurably insane may be dis- 3763- charged by the board of county commissioners to friends willing and able to provide for him. 7. COST OF MAINTENANCE 3I02 - Insane paupers for whom a guardian has been appointed are provided for under the laws regulating the relief of the poor. The expenses for maintenance of a person dangerously insane must be paid out of his estate on direction of the court which has declared him insane, or if the estate is insufficient, or necessary for the support of his family, out of the county treasury. When a person is supported at public expense in a hospital for the insane and is found to have an estate which is not needed for the support of other dependents, the amount of expenses incurred by the state is a charge against the estate. If insane persons committed to a hospital for the insane are not supplied with an ample supply of suitable clothing, the clerk of the county must furnish the necessary supply at a cost not to exceed thirty dollars to be paid out of the county treasury. Inmates of a hospital not otherwise supplied must be furnished by the superin- tendent with the necessary clothing at an expense of not more than twenty dollars per annum for each patient to be charged to the county from which he was committed. 8. CRIMINAL INSANE When the defendant in a criminal cause desires to plead insanity, his defense must be set up in writing. The jury or court trying the case is required to determine whether the defendant was insane at the time of commission of the act and whether not guilty because of insanity at that time. Estate liable. 3111. Laws of 1917, ch. 72. Clothing. Statutes. 3707. 3708. Persons acquitted of crime. 2070. 71 INDIANA If the defendant is found not guilty on account of insanity the 3 7 lb - court must find as to the defendant's sanity at the time of the trial. A male defendant found insane is committed to the hospital for insane criminals, a female to any state hospital where there are females. If the defendant is sane at the time of the trial but a recurrent attack of insanity highly probable, he is committed as above. Any time after six months the insane convict may file in the in which he was committed an application to be discharged and if the judge is satisfied that sanity is restored and recurrence of in- sanity improbable he must order him discharged. A subsequent application for discharge may not be made within two years of a previous one. If a court before the trial, or during its progress but before the D **$ trial> final submission of the cause to the court or jury, believes the de- fendant insane, two physicians must be appointed to examine him and testify at a hearing; other evidence may be introduced to prove the defendant's sanity or insanity. If the court finds that the de- fendant has comprehension sufficient to understand the nature of the criminal action against him and the proceedings thereon and to make his defense, the trial may not be delayed. In event of the opposite finding, the defendant must be committed to the hospital for insane criminals if a male, or to a state hospital if a female. When the superintendent of a hospital certifies ihat the defendant has become sane or the court is sufficiently advised of restoration, the defendant is placed on trial. The sheriff is allowed fees, as for taking insane persons to a 3 7- hospital. Upon certification by the physician of a state prison or reformatory to the superintendent or warden that a convict is insane, the superin- tendent, or warden, if satisfied of his insanity, must report the case to the governor. Upon the order of the governor, to whom he re- ports their findings, the superintendent or warden convenes a lunacy commission, made up of a resident justice of the peace and two physicians, to examine the alleged insane convict and report on his condition. Five days before the holding of the examination, the superintendent or warden must notify the next friend or relative of the convict, and the board of state charities. The governor, if convinced that the convict is insane, orders him committed to the state hospital for insane criminals and orders the general superin- tendent or warden to transfer him. An insane convict receives credit on his sentence for the time he is under treatment in the state hospital for insane criminals. The governor, upon notice from the warden or physician of the hospital for the criminal insane that a convict confined as insane has 3748> INDIANA 72 recovered his sanity, orders him transferred to the penal institution from which he was removed if the recovery occurred before the expiration of the sentence for crime. If the insanity of a convict continues beyond the expiration of his sentence for crime, he is kept in the hospital for criminal insane until he regains .his sanity, but upon certification of his recovery by the physician and warden of the hospital, the governor orders the warden to discharge him and to report his discharge to the institution from which he was transferred, and to the board of state charities. 73 IOWA Authorities : Code of Iowa, 1897 Supplement to Code of Iowa, 1913 Laws of Iowa, 1911 i. ADMINISTRATION AND SUPERVISION a. General. The board of control of state institutions is com- . posed of three electors, not more than two of whom may belong to Supplement, the same political party or reside in the same congressional dis- 2727 " a r - trict, appointed by the governor for terms of six years and subject to removal by him. Each member receives a salary of $3,000 per 2727 ' a " annum and necessary traveling expenses within the state. The board is vested with the management of all state charitable and correctional institutions, replacing the former boards of trustees, and exercises supervisory powers over all county and private institu- Institutions, tions in which insane persons are cared for. The board is required to gather and present information in regard to the best and most successful methods of caring for the insane, to encourage scientific investigations by the medical staffs of the hospitals for the insane and to publish the results of the scientific and clinical work done in 2727 " a " these institutions. The board must make a biennial report to the governor and legislature. The board of control has the direction and management of the w-***' state hospitals for the insane. It appoints for each one a qualified medical superintendent for a term of four years and may remove him s up e nntend- for cause. It fixes the number and salaries of employees, but the discharge of employees is a function of the superintendents. It is obligatory upon the board to make monthly visits to the state hospitals. The county homes (poor asylums) are under the control of the board of county supervisors, who appoint the stewards and scribe the regulations for their management. The county poor- houses with departments for the insane are subject to monthly visits by the board of control of state institutions. b. Institutional. There are no local boards of trustees. 2. CARE a. In state institutions. Mount Pleasant State Hospital, Mt. Pleasant; established, 1850; 1,000 beds. Independence State Hospital, Independence; established, 1869; 1,224 beds. 74 2737-a 28a. 2263. 2265. Clarinda State Hospital, Clarinda; established, 1885; 1,160 beds. Cherokee State Hospital, Cherokee; established, 1902; 1,000 beds. b. In local institutions. Most of the counties (sixty-four in all) maintain county homes having special accommodations for the cure of chronic and incurable harmless insane who are residents of the county. 3. COMMITMENT a. Persons committed. All insane persons, not idiots, with a legal residence in the state are entitled to admission to the state hospitals if found fit subjepts for treatment in these institutions. Persons found to be without a legal settlement in the state who become insane must be cared for in a state hospital, until their legal residence can be ascertained, or they can be transported to it. b. Legal procedure in commitment. Each county has a board of three commissioners of insanity, and in counties where district court is held in two places there is one such board of commissioners at each place, consisting of the clerk of the district court, or his deputy, one physician in actual practice and of good professional standing, and one lawyer in actual practice and of good standing, appointed by the judge of the district court. The appointments may be made by the court for terms of two years. The clerk of the board must sign and issue all notices, appointments, warrants, etc., and file and preserve in his office all papers connected with any inquest by the commissioners. The commissioners have cognizance of all applications for admission to the hospital, or for the safe-keep- ing otherwise of persons within their respective counties, except in cases otherwise specially provided for. Applications, directed to the commissioners of insanity, for admission to the hospital must be made in the form of an informa- tion, verified by affidavit, alleging that the person in whose behalf the application is made is believed by the informant to be insane, a fit subject for custody and treatment in the hospital, and that he is in the county. The commissioners may examine the informant and other witnesses under oath, and may require that the person for whom admission is sought be brought before them, providing for his custody meanwhile. Any citizen of the county or relative of the person alleged to be insane may appear and resist the application, and employ counsel. The commissioners must appoint some regular practicing physician of the county to make a personal ex- amination of the person alleged to be insane. The examining physician must endeavor to obtain from the relatives of the person, or from others who know the facts, answers to prescribed interroga- tories, the answers to be attached to his certificate. If the com- 75 IOWA missioners find the person is not insane, they must order his im- mediate discharge, if in custody; but if insane and a fit subject for custody and treatment in the hospital, they must order his commit- commitment, ment to the hospital in the district in which the county is situated. If at any time it is necessary to discriminate in the general recep- Discrimination tion of patients in a hospital, a selection must be made in the follow- <> f patients, ing order: (1) cases of less duration than one year; (2) chronic cases, where the disease is of more than one year's duration, present- ing the most favorable prospects for recovery; (3-) those for whom application has been longest on file; (4) where cases are equally meritorious in all other respects, the indigent have the preference. The commissioners of insanity, with the consent of the board of counties having no supervisors of any county having insane persons and no proper facili- asylums. ties for their care and treatment, may, with the consent of the 2727-365'. board of control, provide for their care at the expense of the county, at any convenient private or county institution. No person may be confined in any private institution for the Authority of private asylums care or treatment of the insane, except upon the certificate of a to keep insane. 2727-8 66. board of commissioners of insanity of some county in the state, or of two reputable physicians, at least one of whom must be a bona fide resident of the state. The superintendents of the hospitals for the insane are required Questionable immediately to notify the board if there is any question of the 2727-8 29. propriety of the commitment or detention of any patient received. An insane person who can not at once be admitted to a hospital wtsia^ or whose case is appealed must be suitably provided for by commissioners if he can not safely be allowed to go at liberty. He may be cared for as a private patient by relations or friends who will provide for him without public charge. In such case, the commis- sioners must appoint some suitable person special custodian. In the case of public patients, the commissioners must require that they be cared for by the board of supervisors at the expense of the county. On application in behalf of persons alleged to be insane, whose admission to the hospital is not sought, asking for their care as insane within the county, the commissioners, on proof of their insanity and need of care, may provide for them, as in case of other applications. No person who is found to be insane may, pending admission to the hospital, be confined in any jail or place of solitary confinement, 2266< except in cases of extreme violence; and in such a case there must at all times be a suitable person in charge of him. At no time may any female be placed in such confinement without at least one female attendant remaining in charge of her. c. Voluntary admission. IOWA 76 Commission of inquiry. Paid by the county or the state. Supplement. 23083. fffida m t nt and d. Appeal from commitment. On a statement in writing, verified by affidavit, addressed to a judge of the district court of the county in which the hospital is situated, or of the county in which any person confined in a hospital has' his legal settlement, alleging that he is not insane, the judge must appoint a commission of not more than three persons to inquire into the merits of the case one of whom must be a physician, and if two or more are appointed, another must be a lawyer. They must forthwith report to the judge the result of their examination and accompany it by a statement of the case, made and signed by the superintendent. If the judge finds the person not in- sane, he must order his discharge; if the contrary, he must authorize his continued detention. The applicant must pay the costs of the inquiry if the judge finds that the application was made without probable ground. A commission of inquiry may not be repeated oftener than once in six months in regard to the same person, nor may a commission be appointed in the case of any patient within six months of the time of his admission. e. Cost of commitment. The expenses of the arrest, care, in- vestigation and commitment of an insane person without a legal settlement including the costs of appeal, if one is taken and the person is found to be insane on appeal, are paid in the first instance by the county in which the person is found to be insane. If he has a legal settlement in another county of the state, the expenses are to be paid by that county. If the person has no legal settlement within the state, the expenses are paid by the state. 4. CONVEYING PATIENTS TO THE HOSPITAL Unless the patient or some one in his behalf appeals the case to the district court, the commissioners of insanity must direct the sheriff to deliver him to the hospital together with all the documents in the case, or may appoint some other suitable person. No female may be taken to the hospital without the attendance of some other female or some relative. The superintendent, in his acknowledg- ment of delivery, must state whether there was any such person in attendance. Any relative or immediate friend of the patient, who is a suitable person, has the privilege of executing the warrant in prefer- ence to the sheriff or any other person. 5. TRANSFER OF PATIENTS care'to hos^tai Insane persons who have been under care outside of the hospital 2274 - by authority of the commissioners of any county may, on applica- tion, be transferred to the hospital on their warrant. The admis- sion may be had without another inquest at any time within six months after the inquest already had. Code. 2266. Female attendant. 77 IOWA When the board of control finds that any patient cared for at Removal of patients from public expense in any private hospital or county institution violent and his case acute, it may remove him to a state hospital at the expense of the proper county. In like manner, when the board finds a chronic patient in a state hospital, it may order the county to which he is chargeable to remove him to a county or private institution for the insane, but not without the written consent of his immediate relatives or of the commissioners of insanity of the county to which he is chargeable. 6. PAROLE AND DISCHARGE OF PATIENTS Any patient who is cured must immediately be discharged by superintendent and furnished with a certificate to that effect, a copy of which is to be forwarded to the clerk of the district court of the county from which the patient was committed. The record is prima facie evidence of his recovery and restores him to all his civil rights. The relatives of any patient not susceptible of cure by remedial treatment in the hospital, and not dangerous to be at large, have the right to take charge of and remove him. No patient under criminal charge or conviction may be discharged without the order of the district court and notice to the county attorney. 7. COST OF MAINTENANCE Indigent patients are maintained at the expense of the county i which they have a legal residence. If they have no such residence Chap - > 7 they are charges upon the state. When the superintendent of the hospital has been notified that a Co ^ t patient sent to the hospital from one county has a legal settlement in another county, he must thereafter hold and treat such patient as from the latter county; and such holding applies to expenses already incurred in behalf of such patient and remaining unadjusted. Patients in a hospital having no legal settlement in the state, or " 8 3- whose legal settlement can not be ascertained, are supported at the expense of the state. The estates of insane persons and of their relatives are liable for Non-in their support ; and the auditors of the several counties are authorized and empowered to collect from the property of such patients, or from any person legally bound for their support, any sums paid by the county in their behalf. The estates of all patients in state hospitals for the insane who are j*jj ^g 1 nonresidents of this state, and all persons legally bound for their support are liable for the reasonable value of the care and treatment of such patients while in the hospitals. The relatives or friends of any patient jn a hospital have the Co ^ privilege of paying any portion or all of the expenses. IOWA 78 Commitment of insane prisoners. 2280. Insane convicts. 5709. 8. CRIMINAL INSANE In the case of a defendant whose sanity is doubted at any stage of the trial of a criminal prosecution, the proceedings must be sus- pended and a trial had upon the question of insanity. If the ac- cused is found insane and his discharge is dangerous to public peace, the court must order him committed to the department for criminal insane at the state penitentiary. If the defendant is acquitted on the ground of insanity and his discharge is dangerous, the court must order him confined in a hospi- tal for the insane or retained in custody until he becomes sane. On a sworn application made by any citizen stating that a person confined in any prison within the county charged with a crime, but not convicted thereof nor on trial therefor, is insane, the com- missioners of insanity must have the prisoner brought before them, and if they find that he is insane, they must direct his removal to one of the hospitals for the insane, and the superintendent of the hospital designated must receive and keep him as a patient. After an in- vestigation such as contemplated in this section, the commissioners may not entertain a like application within six months on behalf of the same person. When any insane person is thus confined, the superintendent, as soon as such person is restored to reason, must return him to the jail of the county from which he was received. A convict confined in either of the state penitentiaries who be- comes insane must be confined in the department for the insane at the state penitentiary until he has served out his sentence or is pronounced cured, in which latter event he must be held in the penitentiary to serve out his unexpired sentence. 79 KANSAS Authorities : General Statutes, 1915 Laws of Kansas, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of administration of state charitable in- stitutions is composed of three members appointed by the governor for terms of four years, at a salary of S3, 500 per annum. The board administers and enforces the laws relating to the insane and their treatment in or out of hospitals, and has power to make rules and regulations in regard to the licensing, visitation, and inspection of all private institutions for the insane; the forms to be observed in regard to the commitment, transfer, custody and discharge of insane persons; the reports and information to be furnished by superintendents and other executives of all institutions for the insane. The board must visit the state hospitals at least once a month and make an annual report to the governor and biennial report to the legislature. The state hospital for the dangerous insane is under the board of administration, and the physician of the state penitentiary is its medical superintendent. No person or physician may establish a private hospital for care or treatment of the insane for compensation without first obtaining a license from the state board of administration. The application for it must be accompanied by a plan of the premises to be occupied. Before granting any such license, the board must have visited the premises to be licensed. The board may make s> 6 3- such terms and regulations in regard to a license as it deems nec- essary, and may revoke the license of any private hospital or insti- tution for due reasons. Conducting a private hospital or institution 9*31. without a license is a misdemeanor punishable by a fine of ten dol- lars for each day the institution is carried on in violation of law. The county attorney of the proper county must proceed against the offender. b. Institutional. There are no local boards of trustees. The superintend- board of administration, with the consent of the governor, must appoint a superintendent or executive officer of each hospital for the insane. Such superintendent must have at least two years' ex- perience as superintendent in a similar institution or be a specialist in nervous diseases. The board fixes the number of subordinate employees and their compensation. The superintendent, subject / to the rules and regulations of the board of administration, has KANSAS 80 Persons excluded. 9595- Petition. 9597- Examination. Hearing. 9598. personal charge and supervision over his institution and must make his reports to the state board of control. 2. CARE a. In state institutions. Osawatomie State Hospital, Osawatomie; established 1866; '1,365 beds. Topeka State Hospital, Topeka; established 1875; 1,606 beds. Hospital for the Dangerous Insane (in connection with state penitentiary), Lansing; established 1911; 60 beds. Larned State Hospital, Lamed; established 1913; 120 beds. b. In local institutions. Incurable or harmless indigent insane and those who can not be received by the state hospitals are cared for in the county asylums or by the county commissioners, who have control of these institutions, appoint the superintendents and physicians, and may annually select a board of visitors. 3. COMMITMENT a. Persons committed. All insane persons, except idiots and epileptics, who are residents of the state are entitled to treatment in the hospitals for the insane. Any person whose mind, by reason of brain sickness, has become unsound, rendering him incapable of managing his own estate or dangerous to himself or others is defined as insane. No person idiotic from birth, or whose mental development was arrested by disease or physical injury prior to the age of puberty, and no person who is afflicted with simple epilepsy, is regarded as insane, unless the manifestations of abnormal excitability, violence or homicidal or suicidal impulses render his confinement in a hospital a proper precaution to prevent him from injuring others or himself. Insane persons, idiots, imbeciles, and epileptics who are com- mitted by the courts or transferred from the penal institutions are cared for in the state hospital for dangerous insane. b. Legal procedure in commitment. When a person is supposed to be insane, any reputable citizen of the town or township in which he resides or is found may file a sworn statement with the probate judge of the county that the person named is insane and unsafe to be at large, and that the welfare of himself and others requires his restraint or commitment to some hospital for the insane. The statement must be accompanied by the names of two witnesses. If the person alleged to be insane has not been examined by a physician, the judge may appoint a qualified physician of the county to make an examination. Upon the filing of the statement, unless the person alleged to be insane is brought before the court without a writ, or unless it is esent. 02. trial. 81 KANSAS shown that the condition of the patient makes it improper to bring him before the court, the probate judge must direct that he be brought before the court for a hearing. The hearing may not take place until the person alleged to be insane is notified. Inquests in lunacy must be by jury or commission, at the discre- T "^ 9 tion of the court. Inquests must be by the jury when it is demanded by the person alleged to be insane, or by any person acting in his behalf. In such cases the court must appoint competent counsel for the person alleged to be insane. When no jury is demanded or a trial by jury is not expedient, the by physician, probate judge must appoint a commission of two qualified physicians 9<5o ' in regular practice to make a personal examination of the patient and file with the probate court a sworn report of their findings. The commission has power to administer oaths and take sworn testimony. Inquests in lunacy may be in open court, or in cham- bers, or at the house of the person alleged to be insane; the presence bepres e must of the accused is indispensable. 96 2 - A jury of four persons, one of whom must be a physician who has J "$* T 3 i been in regular practice for three years and of good standing, must be impaneled when a case is tried by jury. The person alleged to be insane must be present, represented by counsel, and may challenge jurors as in civil cases. The verdict must be signed by all members of the jury, and contain a brief statement of the medical treatment in the case, signed by the physician .or physicians upon the jury. If the person is adjudged to be insane and a fit person to be sent to a hospital, the court must order his commitment. If not satisfied with the findings of the jury or commission, the probate judge may set them aside, and dismiss the proceedings or order another in- quest. The order entered by the judge in accordance with the r ^f of findings of the jury or commission may -discharge the patient with or 96o6< without conditions or remand him to the custody of his friends, or commit him to some hospital, public or private, in the state, or to a county insane asylum or the insane department of a county alms- house in the county where the alleged insane person resides. Insane persons may be committed to private hospitals or in- ^ ^ 1 a t stitutions in the same manner as to a state hospital for the insane, o on examination and certification by a physician chosen by the state board of administration. Such physicians are appointed in differ- ent parts of the state to serve during the board's pleasure and re- ceive five dollars for each certificate. The probate judge, in selecting a private asylum in cases adjudged insane in his court, must be governed by the wishes of the friends and relatives of the insane person. No county can recover for the care of an insane person confined in a private hospital unless he first KANSAS 82 Nonresidents in private institutions. 9624. Application for guardian. 9607. Order for admission. 9604- To the district court. 9606. 9618. County patients. 9621. Private patients. Non-insane. Nonresidents of county. has been refused admission to one of the state hospitals for want of room, and then only at the rate of $2 a week. Insane persons not residents of the state may not be detained in any private institution in this state unless committed in accordance with the laws of the state or territory of which they are residents or with the laws of this state. Any person filing application for an inquest in the case of a person possessed of any estate may at the same time apply for the appoint- ment of a guardian for him. Having ordered an,insane person committed to a state hospital, the probate judge must without delay make application to the board of administration for his admission, transmitting with the applica- tion a copy of the report of the examining physician and the verdict of the jury or commission, under his signature, and the board must designate the hospital to which he shall be conveyed. c. Voluntary admission. d. Appeal from commitment. Appeals may be made to the dis- trict court from any order or judgment rendered, upon the appellant giving such bond and security as the court may direct. Appeal from commitment may be made on behalf of any person committed as insane, and the question must be decided by the probate court after inquiry, with or without a jury. Such inquiry may not be held oftener than once in six months in regard to the same person and not within six months of the time of the admission of any patient. (See 6. Parole and discharge of patients; habeas corpus.) e. Cost of commitment. In case of county patients, the costs' must be paid from the county treasury; but in case of private pa- tients, the costs must be paid by the guardian or relatives of the insane out of his estate. When a person is found to be sane, the court may require that the costs be paid by the person who filed the statement. When any person residing in the state is adjudged insane by the probate court of any county of which he is not a resi- dent, the probate judge of the county in which the person resides must be furnished with a transcript of the record and findings in the case, whereupon the county becomes liable for the costs of proceed- ings, transportation, clothing and other incidental expenses of commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL If any competent relative or friend of a person committed to a hospital for the insane requests the warrant of commitment, it must be delivered to him for service. In committing female patients to the state hospital, unaccompanied by some relative, the probate 83 KANSAS judge must appoint a female attendant to accompany the sheriff other person to whom the warrant of commitment is delivered. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The board of administration may release patients on parole. Authority to discharge patients from any of the state institutions administration, for the insane is vested in the state board of administration, but may be delegated to the respective superintendents. Discharges may be fendents" 1 " made because the person is not insane, or because he has recovered, Discharge* 01 or because he has so far improved as to be capable of caring for him- self, or because the friends of the patient request his discharge and in the judgment of the superintendent no evil consequences are likely to follow, or because there is no prospect of further improve- ment and the room is needed for others. No patient who is violent, J dangerous or unusually troublesome or filthy may be discharged from any state institution and sent back to any county farm, almshouse or insane department of any almshouse not provided with suitable conveniences and facilities for his care. No patient who has not recovered his reason or who is charged with crime may be discharged until at least ten days' after notice has been given to the probate judge to make some order in regard to the disposition of the patient. Any relative or friend of a patient admitted to a private institu- tion may apply for his discharge to its superintendent; and, in case 9<535 - the superintendent refuses to grant it, may apply to the probate court of the county where the institution is located, which court has authority to hear the application, and may discharge the patient or not. Upon proper notice* that a patient committed on his order been discharged as cured, the probate judge must order the patient 96l? - restored to all his rights as a citizen. At any time subsequent to the discharge of a patient not recovered, the probate judge of the county may hear the evidence tending to show that such patient has recovered, and if satisfied of his recovery, may make a similar order, and thereafter the patient is not liable to commitment to any hospital for the insane without a new inquest. An insane inmate of a county asylum for the poor may be dis- ^ charged by the county commissioners to friends who are willing and able to care for him. A writ of habeas corpus may be presented by any person who, ^eas corpus, under any pretense, is restrained of his liberty. KANSAS 84 9609. Rebate tc -county. 9610. Private patients. 9612. 7. COST OF MAINTENANCE Patients committed to any state hospital for the insane must be designated either as private or county patients. The probate judge must transmit to the superintendent of the hospital a state- ment showing the financial condition of a patient committed by him, and of the persons bound in law to maintain him. Each county is entitled to receive from the state a sum not to exceed $2 a week for each destitute insane person in the county whose admission to the state hospital has been refused for want of room or who has been discharged from the state hospital to make room for another patient. No private patient may be received into any state hospital" for the insane unless there has been filed with the superintendent a bond with sufficient sureties, approved by the probate judge for the pay- ment of all incidental expenses incurred by the institution on his account. Examination of convicts. Laws of 1911, Chap. 299, Transfer of insane convicts. Transfer of dangerous inmates. 3- Insane persons und indictment. 8. CRIMINAL INSANE When a person confined in the state penitentiary, the state industrial reformatory, or any other penal institution in the state is alleged to be insane, the warden, superintendent or other per- son in charge, with the consent of the board in charge of the penal institution, must cause the person to be examined by the probate court of the county in which he is confined, as in the case of other insane persons. If he is found insane, he must be transferred by the order of the probate court to the state hospital for the danger- ous insane. If his sanity is restored before the period of his com- mitment to the penal institution has expired, he must be removed to the institution from whence he came, there to complete the period of his sentence. The period for which he is removed is counted as a part of the term of the confinement. If the insanity continues after the expiration of his sentence, he must be detained in the hospital until his sanity is restored. Any inmate of a state hospital or asylum for the insane or epileptic, or the home for feebleminded found by the state board of adminis- tration to have homicidal tendencies, or to be under sentence or indictment or information, or whose presence is dangerous to the other inmates of said institution, must be transferred to the state hospital for the dangerous insane. Any person under indictment or information found by the court or by commission or another jury impaneled for the purpose of trying such question, to be insane, an idiot or an imbecile, must be forthwith committed to the state hospital for the dangerous insane for safe-keeping and treatment until he has recovered, when he must 85 KANSAS be returned to the court from which he was received to be placed on trial upon said indictment or information. When during the trial of any person on an indictment, or in- formation, evidence is introduced to prove that he was insane, an cr e- idiot or imbecile at the time of the commission of the offense and he is acquitted on that ground, the jury or the court must so state in the verdict and the court must thereupon commit him to the state hospital for the dangerous insane. No person thus acquitted may be liberated from the hospital, except upon the order of the court committing him, and until the superintendent certifies that in his opinion he has wholly recovered. 86 State board of control. Statutes. Appointm of officers ent fficers. Superintend- ent. 343. KENTUCKY Authority : Statutes of Kentucky, 1915 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control consists of four members, two from each of the two leading political parties, appointed by the governor for a term of four years. Members of the board must be at least 25 years old, and have been citizens of the state for the last five years preceding their appointment. A bond of $25,000 is required of each commissioner. Each member receives a salary of $2,500 a year and his necessary traveling expenses. The board has under its control the three state hospitals for the insane and the feebleminded institute. It must hold regular meet- ings at each of the institutions at least once in each month, and make a thorough examination of the affairs, management, property, clothing, food, supplies, condition of buildings and grounds, and the conduct of every official and employee, of which it must make a complete record, together with such rules and regulations as it may give. The board must ascertain whether the objects of the institutions are being properly accomplished and the laws in relation to them fully complied with, and make an annual report to the gov- ernor and a biennial report to the governor and general assembly. The board of control must appoint at each hospital, for terms of four years, a medical superintendent, a first, second and third as- sistant physician, each of whom must be a skillful and competent physician, who has practiced his^ profession at least three years (provision is made for the appointment of a woman physician to each hospital) and a steward. The board may remove them for cause. b. Institutional. There are no local boards of trustees for the state hospitals. The medical superintendent has the general management, supervision and control of the patients, subject to the regulations of the board of control. (His duties in regard to keeping records of patients, their condition, treatment, etc., are prescribed by law in detail.) He must make monthly reports to the board of control of the number of deaths among the patients, and their causes, and of all escapes, recoveries and removals of patients. The superintendent appoints all inferior officers and employees not otherwise provided for and may remove any of them at pleasure. 2. CARE a. In state institutions. Eastern State Hospital, Lexington; established 1824; 1,065 beds. Western State Hospital, Hopkinsville ; established 1854; 1,200 beds. Central State Hospital, Lakeland; established 1873; 1,400 beds. 87 KENTUCKY The statutes require that white and negro patients shall be cared for in separate departments. b. In local institutions. Each county poorhouse must provide for the care of the harmless incurable insane and such other patients as may not be received at the state hospitals. The poorhouses are under the control of the county courts. 3. COMMITMENT a. Persons committed. All insane persons, except idiots, epileptics and the harmless incurable, having a legal settlement in some county are entitled to admission to the state hospitals for treatment at the state's expense. All pauper idiots, epileptics and harmless incurable insane persons, must be returned by the hospitals to the several counties from which 247t they were sent and given into the custody of their friends if any; if not, then to the county judge, or, if they are residents of and sent from the city of Louisville, then to the mayor of that city who must make suitable provision for their support. The hospitals must also return each paying patient of the aforesaid classes to his county of residence, or whence he came. When upon application to the proper hospital a patient is rejected 250< for want of room, immediate application must be made to another. The board of control must take care that each of the hospitals is kept full to its utmost capacity of such patients as are receivable by it as long as any of them in the state are unprovided for. Resident patients always have preference over pay patients from other states, 253> and any patient found insane must be received. b. Legal procedure in commitment. Inquests to determine ^Ig- whether a person is of unsound mind (idiot, lunatic, non compos) must be held by the circuit court of the county. If no circuit court is in session in the county, the inquest may be held by a judge of a circuit court or by the presiding judge of the county court; but in no case may an inquest upon an idiot be held except in the circuit court. The judge may make all orders for the care of the person found to be of unsound mind or imbecile or incompetent to manage his estate, and must, if necessary, make all orders for the appoint- ment of a committee and the security -of the estate and care of the person in question. The judge holding the inquest may order a person found insane to the state hospital; but in no case may an order be made to send an idiot to a state hospital unless the jury, by their verdict, finds that he is so dangerous or uncontrollable that he can not properly or safely be kept by a committee at home. The personal presence of the person charged with being of unsound Examination, mind is required, unless it shall appear by the oath or affidavit of KENTUCKY 88 two regular practicing physicians, that they have personally ex- amined him and find him to be insane, and that his condition is such J^y^p* 1 - that he would be unsafe to bring into court. The case must be heard Ju ai g 59? nt ' before a jury. If the judge is satisfied with the inquest, judgment must be entered accordingly, or he may order the inquest set aside if he finds it contrary to law or not sustained by the evidence, and order a new inquest. Re ai6o' Whenever it appears to the county or circuit court from an affida- vit filed that a person found of unsound mind has been restored to his proper senses, or that the inquest was false or fraudulent, the court must direct the facts to be inquired into b"y a jury in open court, and make all necessary orders or decrees in the premises. Hi 2i67 fcase ' When a person has been found to be insane, the presiding judge must endeavor to ascertain and draw up a brief history of the patient's case, covering certain specified points, and transmit the same to the hospital to which the patient is sent. ?a 33. c . Voluntary admission. d. Cost of commitment. The expense of committing and trans- porting indigent patients is paid by the state unless they have sufficient estate. 4. CONVEYING PATIENTS TO THE HOSPITAL At S!?7?S" ^ e circuit court or county judge ordering any person to be sent to a hospital for the insane must notify the superintendent, advising him of the sex and condition of the person, and the superintendent must immediately send a competent attendant to convey such person to the institution. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS parole. rp ne superintendents of the several hospitals may permit the family or friends of patients, whose condition of mind and health is such that they may be taken care of and treated properly outside of the hospital, to be removed from it, either permanently or for such length of time as the superintendents may deem prudent. No Di !s5? rge ' patient may be discharged as cured except by the authority of the superintendent. Any cured patient who was admitted to the hospital while in custody or upon a criminal charge, must be delivered to the keeper of the penitentiary or to the jailer of the county whence he came. A cured pauper, before being discharged, must be fur- nished with clothes and enough money to pay his traveling expenses to his home. 89 KENTUCKY 7. COST OF MAINTENANCE A pauper idiot or insane person, who has been found so by the ver- ^e. by ** diet of a jury, or committed by order of court and who has no estate 2I7a I4> sufficient for his support and no relatives liable for his support, must be cared for in a state hospital at the expense of the state. When the patients supported in the state hospitals acquire n t r r oi{nay estates which can be subject to debt, the board of control must sue for and recover the amount of such patient's board at the rate of $150 per year, or so much of it as the estate will suffice to pay. The board of control must sue for and recover from persons liable for the support of patients provided they have sufficient estates. Pay patients are charged a fixed sum per annum to be paid in Pa / 5 P atients - advance for the first six months, and security must be furnished for payment for the remainder of the time they may be in the hospitals. But if the patient be discharged or die before the expiration of the six months paid for, a proper proportion of the amount paid must be refunded. 8. CRIMINAL INSANE When the sanity of a person appearing for trial is questioned, or a defendant alleges insanity as a cause against judgment, a jury of twelve must determine the question. If found insane, the defendant may be kept in prison or county jail or conveyed to the nearest state hospital at the discretion of the court. If sent to the * 53 ' state hospital, the accused must be returned to the sheriff upon demand. A defendant acquitted on the ground of insanity may be com- mitted by the court to a state hospital. 90 LOUISIANA Authority: Marr's Revised Statutes of Louisiana, 1915 i. ADMINISTRATION AND SUPERVISION charities a< General. The state board of charities and correction consists R n evisedf ction ' f s ^ x members who serve without compensation, appointed by the Sta 79if s ' governor for terms of six years. The governor is ex-officio chairman of the board. The duties of the board are strictly visitorial, without administrative or executive powers. It has the duty of inspecting all state or local charitable and correctional institutions. The board makes report to the governor annually and to each legislature, administrators. & Institutional. Each of the hospitals for the insane is governed 3431- by a board of administrators, consisting of eight members appointed ,by the governor with the advice of the senate from the state at 3432. i arge f or terms of four years. The governor is ex-officio president of mfttee! ive c m " ^ ne boards. Each board has an executive committee of four mem- bers, which must visit its institution at least monthly. |g The boards, which must hold at least four meetings a year and 3436. make a full report to the legislature at each session, make all rules and regulations for their own government ; elect the super- intendents of the hospitals, in one case to serve for four years; in the other, during good behavior; remove superintendents for cause; and determine the salaries of the officers. Superintendents name their assistant physicians and other officers, who are subject to removal by the boards upon their recommendation. 2. CARE a. In state institutions. East Louisiana Hospital for the Insane, Jackson; established 1846; 1,460 beds (with a ward for criminal insane). Louisiana Hospital for the Insane, Pineville; established 1906; 620 beds. b. In local institutions. The police juries of the different parishes have the duty of caring for insane persons who can not be received at the hospitals and may provide for them on poor farms or in homes. 3. COMMITMENT 344 * a. Persons committed. Indigent insane persons, residents of the 3439t state, are entitled to admission to the hospitals for the insane. The board of administrators has authority to receive patients not com- mitted by a judge on such terms as it may fix. wmpuSnt. b. Legal procedure in commitment. On written complaint or information of any respectable citizen to the judge of the district 91 LOUISIANA court that any insane person within his jurisdiction ought to be sent to one of the state hospitals for the insane, the judge must order the person to be brought before him, and summon two licensed Summons - and reputable physicians, one of whom must be the coroner of the parish, and the other the physician of the suspected person, if he has any, neither of whom may be related by affinity or consanguinity to him or have any interest in his estate. The judge and the two physicians constitute a commission to inquire whether the person is insane and a suitable subject for a hospital for the care and treat- ment of insane persons; and for that purpose the judge must summon witnesses who know the person suspected of insanity. The phy- Wltnesses - sicians in the presence of the judge must by personal examination satisfy themselves and the judge as to the mental condition of the Exammation - suspected person. If the two physicians do not agree, the judge commitment, determines the issue. (The recorders of the city court of New Orleans may, however, commit insane persons.) The coroner must 3469> ascertain all necessary facts to enable him to answer the questions prescribed in the form of certificate. c. Voluntary admission. d. Appeal from commitment. e. Cost of commitment. The expense of examining and convey- 3469< ing an insane person to the hospital is paid out of the parish treasury. 4. CONVEYING PATIENTS TO THE HOSPITAL Upon a warrant by the committing judge, the sheriff has the duty 3469> of conveying an insane person to the hospital. 5. TRANSFER OF PATIENT The boards of administrators through their executive committees By 3 $J3 board> may in their discretion transfer inmates from one to the other hospital. 6. PAROLE AND DISCHARGE OF PATIENTS Authority to discharge patients upon recovery or for other causes is vested in the superintendents, subject to the order of the re- spective boards. 7. COST OF MAINTENANCE Except that patients who are not committed by a judge may be J^^ t ^ id by received on terms fixed by the hospital boards, there is no charge for 3440. the maintenance of patients at the state hospitals. LOUISIANA 92 8. CRIMINAL INSANE c f ^ n ment When a person arrested for a crime or misdemeanor before any Scquhted of court of the state is acquitted by the jury, or not indicted by the cri 3476. grand jury by reason of insanity, and his liberation is deemed by the court to be dangerous to safety, the court is authorized to commit him to the hospital for the insane or to a similar parish institution until he is restored to his right mind. insa^'Sons * ^ an y person charged by affidavit, information or indictment r or omvicted'of wth the commission of any crime is found to be insane before trial "3471. or a fter trial and conviction, the court must order him to be com- mitted to the ward for the criminal insane until he has been com- pletely restored to sanity. If any such person committed to the ward for the criminal insane, in the opinion of the superintendent, is not insane, or when he has been completely restored to sanity, he cu^to^on must be sent back to the jail or custody and held for trial, or that recovery. sentence may be executed upon him. The superintendent of the state hospital for the insane must as often as the court requires furnish information of the status of the criminal insane during his confinement. hospitatVf When a convict serving a sentence in the penitentiary becomes convkts insane, the general manager "of the penitentiary must petition the 3459- court where the penitentiary is located for his removal to a hospital for the insane. The judge must hear and determine the question of the convict's insanity in the same manner and by such proofs as are required by the law for the interdiction of other insane persons. If satisfied that the convict has become insane during his imprison- ment, the judge must order his removal to the hospital for the insane. Upon recovery, the convict must be returned to the penitentiary, to serve out the unexpired portion of his sentence. receive of of When any person confined in the ward for the criminal insane has to'^sMt^o rec overed his sanity, who was not guilty of the crime with which he Cle 3 1 4 *72? c urt< was cnar S e< i because of insanity, the superintendent of the hospital for the insane must notify the clerk of the district court of the parish wherein the crime was committed, and the sheriff of that parish must return him to the parish for trial. s No person committed to a state hospital for the insane who recover^ 11 became insane after his conviction for a crime punishable by im- 3473. prisonment in the penitentiary or by death, may be restored to liberty upon regaining his sanity, but must be delivered to the custody of the sheriff of the parish wherein he was convicted in order that the sentence of the court may be executed. When any person charged with a felony necessarily punishable in the state penitentiary or by death, has been adjudged insane, before or after trial or conviction, and committed to a state hospital for the insane, he 93 LOUISIANA must not be discharged from the hospital for the insane or delivered into the custody of the proper sheriff until the superintendents of the two state hospitals for the insane and, in case of their disagreement, a physician appointed by the judge of the district court from whence the criminal insane person was committed, are satisfied after a thorough examination that he has been completely restored to sanity and may be discharged without danger to others. 94 Board of charities and corrections. Revised Statutes, ch. 147. MAINE Authorities: Revised Statutes of Maine, 1916 Laws of Maine, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of charities and corrections consists of Committee of trustees, ch. 145. i. five persons, at least one of whom must be a woman. The members are appointed by the governor, with the consent of the council, for terms of five years. They serve without compensation but receive their" expenses. The board approves all rules and regulations governing the ad- ministration of state institutions. Meetings must be held quarterly and oftener if required. Yearly inspections must be made of each institution by a member of the board or an agent. Biennial re- ports must be made to the legislature and quarterly reports to the governor. The state hospitals for the insane are under the management of a committee of seven trustees, one of whom must be a woman, ap- pointed by the governor with the advice and consent of the council, to hold office during the pleasure of the governor and council, but not for more than three years under one appointment. In addition to the general care and management of the hospitals,, the trustees are authorized to establish by-laws for their internal government and economy, and to appoint a superintendent, steward and treasurer for each hospital, subject to the approval of and ta hold office during the pleasure of the governor and council, and all other necessary officers. Each hospital must be examined monthly by two trustees, quar- terly by three, and annually by a majority of the full board, and at any other time when they deem it necessary, or the superin- tendent requests it. A committee of two, with whom must be associated one woman,. 381 are appointed by the governor annually to visit both hospitals to- ascertain the treatment given the inmates, and they must promptly report every instance of abuse or ill-treatment to the trustees and superintendent of the hospital. superintendent, jj. Institutional. The superintendent of each hospital must,, among other things, receive all patients legally sent to the hospital, unless the number exceeds the accommodations, and apportion the * number of patients who can be accommodated in the hospitals- among the towns, according to their population at the last census. When applications for admission exceed or are liable to exceed that Committee of visitors. 95 MAINE number of patients, he must give preference to those from towns that have not their full proportion of patients in the hospital, and I0 - may reject other-s. When a person has been unlawfully committed, the superintendent must report the case to the trustees, and they may have the person removed to the town from which he was committed. The superintendent, at each monthly visit of the trustees, must report to them any inmate who was idiotic at the date of his commitment, and who has become so imbecile as to be beyond cure, and if he thinks that such inmate may safely be dis- charged, the trustees must order his discharge and removal to the town by which he was committed. 2. CARE a. In state institutions. Augusta State Hospital, Augusta; established 1840; 1,000 beds. Bangor State Hospital, Bangor; established 1901; 600 beds. b. In local institutions. Harmless incurable and other insane who can not be received at the state hospitals may be provided for at the town almshouses, which are under the care and manage- ment of the overseers of the poor of the town. 3. COMMITMENT a. Persons committed. All insane who are legal residents of a town are entitled to admission to the state hospitals for the insane. b. Legal procedure in commitment. Parents and guardians insane minors, if of sufficient ability to support them there, must cb within thirty days after an attack of insanity, without legal ex- amination, send them to one of the hospitals and give to the treasurer the bond required, or they may send them to some other hospital for the insane, within this period. Insane persons, not thus sent to any hospital, are subject to . m&tioQ examination. The municipal officers of towns constitute a board I7> of examiners, and on complaint in writing of any blood-relative, ^^ lcipal husband or wife of an alleged insane person, or of any justice of the peace, they must immediately inquire into his condition, appoint a time and place for a hearing, and notify the person alleged to be insane. They must take the necessary testimony, and if they think such person insane, and that his comfort and safety or that of others interested will thereby be promoted, they must forthwith send him to either one of the insane hospitals with a certificate of insanity, and direct the superintendent to receive and detain him until he is restored or discharged. The patient may be committed to the insane * s ao of I91 asylum while the commissioners are acting upon the application. MAINE 96 SSSs. f To establish the fact of insanity, the evidence of at least two reputable physicians given by them under oath before the board of examiners is required, together with a certificate signed by the physicians and filed with the board, the evidence and certificate to be based upon due inquiry and personal examination of the person in question. may The judge of probate in the several counties likewise has power to and examine insane persons, and upon complaint in writing of any blood- statutes relation, husband or wife of the alleged insane person, or of any ch js 4S ' justice of the peace, accompanied by the certificates of some rep- utable physician stating that in his opinion the person is insane, may immediately appoint a time and place for hearing the case within the town or city in which the person resides or is found. The judge of probate has power to summon witnesses, and if the person is found insane, the judge must forthwith send him to one of the hospitals for the insane, directing the superintendent to receive and detain him until he is recovered or is discharged. The registrar of probate must keep a record of the doings in each case and furnish a copy to any interested person requesting and paying for it. The municipal J ba d te C court** ffi cers or * ne judge of probate first taking jurisdiction of a com- officers nicipal pl am ^ have exclusive jurisdiction in the matter until the complaint 2 7- is finally disposed of. In case of refusal to commit by one of these tribunals after notice and hearing, no complaint may be made to the other tribunal with reference to the same person within thirty days after the decision is recorded; and only after application to each of said tribunals and neglect or refusal for three days on the part of each to act, may further proceedings be taken. c. Voluntary admission. *9- d. Appeal from commitment. Persons liable for the support of a patient who has been in either hospital for six months and who has , not been committed by the supreme judicial court and is not afflicted with homicidal insanity, may apply to the municipal officers of the patient's town for his release, if they think him -unreasonably de- 3 8 - tained. If the application is unsuccessful, it may not be renewed until the expiration of another six months. When the committee of visitors becomes satisfied that an inmate, other than one charged with or convicted of crime and committed by order of court, is Habeas corpus, unnecessarily detained, they must apply for a writ of habeas corpus; and if the judge issuing it is satisfied, after due hearing, that the inmate is not a proper subject for custody and treatment, he must 44- discharge the inmate. When the superintendent of either hospital is in doubt as to the legality of the commitment of any person, he may apply to the judge of the municipal or police court of the city 97 MAINE where the person is detained under commitment, asking for an inquiry and decree in the case. e. Cost of commitment. The town in which an insane person S^sidSts. resided or was found at the time of his arrest is liable for the expense ch ;^ 5 ' of his examination and commitment. Any town thus made charge- able may recover the amount paid for examination and commitment from the insane person, if he is able to pay, or from persons liable for his support, or from the town of his settlement. If he has no legal settlement in the state, the expenses must be refunded by the Nonre sidents. state. 4. CONVEYING PATIENTS TO THE HOSPITAL If a wQman is committed to either of the insane hospitals, the ^"ndant. magistrate committing her must, unless she is to be accompanied ch j** s- by a father, husband, brother or son, designate a woman to be an attendant or one of the attendants to accompany her. 5. TRANSFER OF PATIENTS The trustees may transfer any patients from one hospital to the^[ t 1 h 4 e 5 * rustees - other, whenever, in their judgment, the welfare of the patients or of s ~ either institution will be promoted thereby. The expense is to be paid out of the funds of the hospital transferring the patient and is a charge upon the person liable for the board of the patient. If the ansfer. board of the patient is paid by the state, the expense of the transfer must be paid by the state. The trustees are empowered to transfer feebleminded persons from f/ebTemuXd the insane hospitals to the school for feebleminded, and insane ins 6 t j tution ' inmates of that school to either insane hospital. A copy of the certificate of commitment to the hospital, together with a certificate of the superintendent declaring the patient to be feebleminded and not insane, and a certificate signed by the secretary of the trustees of the hospital showing that they voted the transfer, authorizes the superintendent of the school for feebleminded to receive the patient in the same manner as if he had been originally committed to this institution. The expense is paid as for other transfers. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of any public institution used wholly or in %, Ij>I7t part for the care of the insane, may permit any inmate temporary ch - 90 ' leave of absence in charge of his guardian, relatives, friends or by himself for a period not exceeding six months. He may be returned by them or upon his own application within six months without a new commitment, and the liability of the state, the town, or obligator by bond for his support remains in full force upon his return. The period may be renewed by the superintendent. MAINE 98 Discharge. Revised Statutes, eh. 145. 3- Discharge to custody of friend. Discharge by trustees. ch. 145. 4- Insane convicts. Liability of towns, ch. 145. 31. Paid by the state, ch. 145. 20. Nonindigents. 38. Recovered by towns. 29. A person committed to a hospital for the insane may be discharged by any justice of the supreme judicial court on satisfactory proof that his discharge will not endanger the peace and safety of the community; or the justice may, on application, commit him to the custody of any friend who will give bond to the judges of probate of the counties in which the hospitals are located, conditioned for his safe-keeping, and the payment of all damages which any person may sustain by his acts. And when, on satisfactory proof, he is again found to be insane and dangerous, any justice of the supreme judicial court may, by a precept stating the fact, recommit him to the insane hospital from which he was discharged. At the annual meeting of the trustees, they, with the superintend- ent, must make a particular examination into the condition of each patient, including patients committed while under sentence in the state prison or any of the county jails, and discharge any one so far restored that his comfort and safety and that of the public no longer requires his confinement. They may transfer to the care and cus- tody of his relatives and friends applying therefor, on conditions, any patient not held under sentence whom they are satisfied will be properly cared for by the person making the application. When the overseers of the poor of a town, liable for the expenses of examination of a patient and his commitment to either hospital, are notified by mail by the superintendent that he has recovered from his insanity, they must have him removed to their town, and if they neglect it for 15 days, the superintendent must have it done at the expense of the town. 7. COST OF MAINTENANCE The officers ordering the commitment of a person unable to pay for his support, or becoming unable after commitment, must certify the fact to the trustees and that he has no relatives liable and of sufficient ability to pay for his support; in which case the town of his legal residence is liable for the cost of his examination and commit- ment, while the cost of his support at the hospital is chargeable upon the state. When the friends of an insane person or others file a bond with the treasurer of the hospital in which he is confined, the state is not liable for his support, unless new action is had by reason of the inability of the patient or his friends longer to support him; and such action may be had in the same manner and before the same tribunal, as if he had never been admitted to the hospital. Any town made chargeable for the commitment and support of an insane person at a hospital, may recover the amount paid from the patient, if able, or from persons legally liable for his support, or 99 MAINE from the town where his legal settlement is; but if he has no legal settlement in the state, the expenses must be refunded by the state. If the trustees of the hospital find that any person or municipality mor is lawfully liable for the support of an insane patient, they must lia je- proceed to collect all sums which have been paid by the state to the hospital for board of the patient from the person or municipality lawfully liable for his support, and thereafter the state is not required to pay for such support, so long as the liability of any person or municipality continues. 8. CRIMINAL INSANE When a person indicted for an offense or committed to jail on a criminal charge makes a plea of insanity, the justice of the court ^ sa before which the case is to be tried may order him sent to one of the * hospitals for the insane for observation and report by the superin- tendent of the hospital. When the grand jury omits to find an Persons indictment against a person by reason of his insanity, they must so because of certify to the court; and when a traverse jury for the same reason m ^ mty acquit any person indicted, the court may commit him to the insane department of the state prison, or to either of the hospitals for the insane. Any person thus committed must be discharged by the 3- court having jurisdiction of the case only on satisfactory proof that he will not endanger the peace and safety of the community. Upon proof that such person has again become insane and dangerous, any justice of the supreme judicial court may recommit him as insane. If a person convicted of any crime, in the supreme judicial court or p o ers ? c ns in either superior court, is found insane when motion for sentence is thou h 's**e. made, the court may commit him to the insane department of the state prison, if the crime is punishable by imprisonment in this institution; otherwise the commitment must be 1 to one of the hospi- tals for the insane. If, at the expiration of the period of commitment to the insane department of the state prison, the person has not recovered, he must be transferred to one of the hospitals for the insane. Insane persons transferred from the insane department of the Transfers, state prison to either of the insane hospitals, upon satisfactory proof that such detention in such hospital will have a bad influence on the other patients, may be returned by the order of the governor and council. Insane inmates of the reformatory for women may be transferred }Jp ^j r to the hospitals for the insane by the Western Somerset municipal for women, court, upon the application of the superintendent. The court must ch.88. hold a hearing, give due notice to all parties and have the inmate examined by two physicfans. MAINE 100 ved 0nTiet *' The governor must appoint in each county a competent physician, ?K. S ' a resident of the county, to act as an examiner of insane convicts in s ' the county jail of the county. When a convict in the state prison or the county jail becomes insane or a convict whose sentence has expired is there detained as insane, the prison physician and the examiner in the county must be notified and must investigate the case. If the convict or person detained is found to be insane, the warden or keeper of the jail must apply to the proper court for a decree. If after hearing the sworn evidence of at least two reputable physicians not in the employ of the state prison or other state jails, the judge determines that the convict or person detained is insane, he must commit him if held in the state prison to the insane depart- ment of the state prison, and if held in one of the county jails, he must commit him to one of the state hospitals. The certificate of the judge stating the town in which the prisoner or person detained resided is sufficient evidence to charge the town for the expenses of his support, if he is detained after the sentence on which he was originally committed has expired, but when his friends or others file a bond with the treasurer of the hospital in which he is con- fined, such town is not liable for his support. If a person so com- mitted is restored or discharged before the expiration of the term of the sentence on which he was originally committed, he must be returned to the prison and serve out the remainder of his original sentence. A friend of any person adjudged to be insane and committed to the convict^ insane insane department of the state prison under the foregoing proceed- ings, who believes him to be unreasonably detained, may apply in writing to any justice of the supreme judicial court, who must in- quire into the case. . Hearing. Liability for support. 7- Recovery of. reason. Judicial inquiry into K 2 LJ C bJ O 101 MARYLAND Authorities : Bagby's Annotated Code of Maryland, 1911 Laws of Maryland, 1910, 1916 i. ADMINISTRATION AND SUPERVISION a. General. Four commissioners, appointed by the governor JJ^SS sion. for terms of four years, together with the attorney-general, con-. d - stitute the state lunacy commission. Two of the members must be J3- physicians, graduates of some legally authorized medical college r s- and must have been in actual practice at least five years consecu- tively just preceding their appointment. One of the physicians must have had at least two years' experience in the treatment of l6 - the insane. The commissioners serve without pay. They are l8 - required to hold monthly meetings. The lunacy commission has supervision of all matters relating to ^^ s f I9IO> the custody, care and treatment of the insane; is required to do^*- whatever may be possible to ameliorate and improve their condition I 9- and to secure them all their rights and privileges as involuntary wards of the state. The commission has full power to investigate all institutions, public and private, authorized to receive insane persons, and to call for such information as it may need. The secretary of the commission must visit all public and private in- stitutions for the insane, including county almshouses or asylums at least once in six months, ascertain whether the laws governing the care of the insane are observed, and examine the condition of build- ings and inmates, as well as records and methods of administration. It is mandatory upon all officers of institutions for the insane to furnish the information required by the commission. Refusal to do so is punishable as a misdemeanor. The commission has power to require written reports from all 2 *- institutions for the insane and to require records of patients in the form it may prescribe. The commission must encourage scientific J 9- investigations by the medical staffs of the various institutions and may publish the results. The commission is required to make an annual report in detail to the governor. The lunacy commission is required to divide the state into hospital ^^ f I9I ' districts for the proper care and custody of the insane. 389. All institutions for the care or custody of the insane must beP^ ions licensed by the commission, except state or incorporated institutions de - and county almshouses, unless the latter receive patients for pay. 2 7- On applying for license full plans of proposed institutions and other details required must be submitted to the commission. Upon its MARYLAND 102 refusal to grant a license an appeal may be taken to the superior court of Baltimore or -to the circuit court. Board o_ b. Institutional. The state hospitals are under the control of boards of managers of nine members each, appointed by the governor for terms of six years, who serve without pay. The boards ap- point the superintendents and the other physicians and officers necessary for the management of the hospitals, and have power to 6- remove them. The managers make all the rules and regulations for the government of the hospitals and are required to inspect them at stated intervals. Board of A board of visitors of five members, two of whom must be women, visitors. art. 59- may be appointed by the lunacy commission for each county asylum and almshouse where insane are confined. The power of such a board is limited to inspection and recommendations to the lunacy commission, to which it must make monthly reports of visits. 38. No institution for the insane is authorized to hold more than five insane persons in confinement unless there is a physician in regular attendance. 2. CARE a. In state institutions. Spring Grove State Hospital, Catonsville; established 1797; 600 beds. Springfield State Hospital for the Insane, Sykesville; established 1896; 1,500 beds. Crownsville State Hospital, Crownsville; established 1911; 500 .beds (for negro patients exclusively) . Eastern Shore State Hospital, Cambridge; established 1912; 300 beds. 9. b. In local institutions. There are no local institutions for the insane, the state having made complete provision for their care. 3. COMMITMENT a. Persons committed. All insane persons are entitled to ad- mission to the state hospitals for the insane. certificate. b. Legal procedure in commitment. The county commissioners, and the supervisors of charities in the city of Baltimore, must cause indigent insane persons who have no relatives or others liable for their support to be ent, upon the written certificate of two qualified physicians, to the almshouse of the county or city to which they belong, or to a hospital or some other place better suited to their condition. If demanded by an alleged insane person or his relatives or friends, or on the request of the county authorities or of the super- visors of charity in Baltimore, the circuit court of the county or the jury trial. criminal court in Baltimore must convene a jury to inquire into the insanity of the person concerned. If the authorities before whom 103 MARYLAND the person is brought are not satisfied that he is insane, the state's attorney of the county or of the city of Baltimore must be notified and immediately bring the question before the circuit court or the criminal court of Baltimore for determination. Relatives or friends of such insane persons may confine them and provide for them. No person may be committed or confined in any institution for the ^eifvaifd insane except upon written certificate of two qualified physicians, 31. made within one week after examination of the alleged insane person, stating his insanity and giving the reason for their opinion. It is 32. unlawful for any physician to certify to the insanity of any person for the purpose of committing him to any hospital or institution for the insane, with which the physician may be in any manner con- nected or interested. c. Voluntary admission. The medical superintendent or chief JJJJIJgn* 7 officer of any institution for the insane, except almshouses, may tendent. . ..... . Laws of I 9 j6 receive voluntary patients who make application in writing, provided ch - s<>6. that the expense be borne by the person applying or by his relatives or friends, or provided that the county commissioners or supervisors of city charities of Baltimore consent to his maintenance as a public charge. No voluntary patient may be detained for more than three days after having given notice of desire to leave the institution un- less he in the meantime has been legally committed. No person may be received or detained as a voluntary patient whose mental condition is such or becomes such that he can not comprehend the act of voluntary commitment or is unable to request a discharge, or to give continuous assent to detention. Every voluntary patient must be reported to the lunacy commission, with a statement of his mental condition at the end of each three months of his residence in the institution. d. Appeal from commitment. The lunacy commission at any gj^*" ^P" 8 - time when it believes a person confined in any institution as insane art - SP- to be not insane, may bring the matter to the attention of the proper state's attorney who must apply to the proper tribunal for the writ of habeas corpus. After inquiry, the court must discharge the person if found sane, or order him returned to the institution if found insane. e. Cost of commitment. The expense of securing the commitment of insane persons is a charge upon the county from which they are sent. 4. CONVEYING PATIENTS TO THE HOSPITAL No female patient may be conveyed to any institution for the f^*^ at ~ insane or transferred from such institution except when accom- ^ WS j f I9IO> panied by some .relative, friend or nurse of the same sex, unless ac- 38t>. companied by her father, husband, or adult brother or son. MARYLAND 104 By the com- mission. 3 8b. Parole. Laws of 10 10, ch.7i5. Discharge. Code. 3 8d. Nonindigents. 5. TRANSFER OF PATIENTS The lunacy commission may transfer acute or violent insane patients confined in a private institution to a state hospital at the expense of the county in which the patient is found. 6. PAROLE AND DISCHARGE OF PATIENTS Whenever in the opinion of the chief medical officer of any in- stitution for the insane it may benefit a patient to be granted leave of absence or parole on trial, he may grant it for not exceeding six months, with the privilege of renewal for not over thirty days, upon application in writing endorsed by the relatives, friends or other persons at whose expense the person was first committed, and who must assume responsibility for his care. No subsequent extension of leave of absence may be made, and no patient may be again ad- mitted to any institution who has been absent from it for more than sixty days, or for more than thirty days, in case the parole had not been extended as above provided, except under a new commit- ment. Any such patient may be returned by his friends or brought back by the duly designated officers of the institution at or before the expiration of the period of parole. The superintendent or chief medical officer of every institution for the insane must discharge a patient, except one under criminal charge, if satisfied that he has recovered. He may also discharge any quiet and harmless patient who is not likely to show a further improvement, if he is satisfied that such patient will be properly cared for and supervised. He may not discharge any person whom he has reason to believe to be dangerous to himself and others, except upon the order of some competent court. The relatives or friends may remove a patient maintained at private expense at their dis- cretion at any time; but in the case of a person believed by the super- intendent of the institution to be dangerous to himself and others, he must give notice to those making the removal that the patient is dangerous, state his reason for this belief, and file a copy of such notice with the papers upon which the patient was committed. 7. COST OF MAINTENANCE No person may be treated as an indigent in any home or hospital for the insane in the state, who possesses sufficient income for his support or who has relatives who are able to pay for it. When an insane person is not able to pay the whole cost of his main- tenance but may be able to pay for part of it, the supervisors of the city charities of Baltimore, and elsewhere the county commissioners, may designate the rate per week which shall be reimbursed to the county or to Baltimore city. 105 MARYLAND If an insane person is possessed of sufficient property to support c t de him in any hospital or asylum for the insane, the court must appoint - a trustee for the estate of such person under bond that will cause the insane person to be confined and supported in some hospital. The expense for the care and treatment of all patients in the j^f e " f ts - state hospitals for the insane is a charge upon either Baltimore city <*. 715- or the county sending them to the extent of one hundred dollars; the state treasury pays the balance of the cost of board, care, and treatment. When a patient is held to be a charge upon another county than the one made responsible for his maintenance in the first instance, the state comptroller must determine the patient's legal residence and issue orders accordingly. When a patient is not a proper charge upon any county, he must be supported by the state. 8. CRIMINAL INSANE When a person indicted for a criminal offense alleges insanity and Persons~wait- the jury finds him insane, the court trying the case must cause him Laws of 1916, to be sent to a hospital or some other suitable place, until he has s- recovered his reason. Any judge of the circuit court of any county where such a person is detained, or of the supreme bench of Balti- more city may, upon habeas corpus proceedings, order absolutely or conditionally the permanent or temporary discharge of the person upon proof of temporary or permanent recovery. If a person 6. arrested for any offense or charged with any crime appears to the court to be insane, the court may cause an inquiry by the lunacy commission and if they find the person insane the court must direct his confinement as above until his recovery. The board of directors of the penitentiary or house of correction Examination of 7 . ... convicts. +4 may summon the lunacy commission to examine into the mental Laws of 1910, condition of the convicts, ancj if a convict is adjudged insane or 38f. ' feebleminded by the lunacy commission or the majority thereof and his removal seems advisable, the commission must make complaint to the judge of the criminal court of Baltimore or of one of the circuit courts, who has 'power to order the removal of the convict to a state hospital at the expense of the state. 106 MASSACHUSETTS Commission on mental dis- eases. Acts of 1916, ch. 283. Acts of 1914, ch. 762. 3- Acts of 1909, ch. 504. 6. Acts of 1914, ch. 762. 5- Acts of 1916, ch. 285. 5. Psychopathic hospitals. Acts of 1917, ch. 115. Acts of 1916, ch. 285. 3- Authority: Acts of Massachusetts, 1909, 1910, 1911, 1914, 1915, 1916, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The general supervision of all institutions, public and private, for the insane, feebleminded, epileptic, inebriates and drug habituates (except one state hospital for inebriates) is vested in the commission on mental diseases, consisting of five persons ap- pointed by the governor with the advice and consent of the council for terms of five years. The director and two associate members must be physicians and experts in the care and treatment of the insane. The director receives a salary fixed by the governor and council, not to exceed $7,500; all members are reimbursed for ex- penses incurred in the performance of their duties. The director is the administrative and executive head of the commission. He ap- points such agents and subordinate officers as the commission deems necessary and fixes their compensation subject to the approval of the governor and council. The commission is required to make an annual report in regard to the work of each institution under its charge, including classified statements of receipts and expenditures and 'estimates of expendi- tures for the year ensuing. It is required to encourage scientific in- vestigation by the medical staffs of the various institutions under its supervision and to publish from time to time bulletins and reports of the scientific and clinical work done . It has charge of the construc- tion of all new buildings or new institutions and the selection of the site of any new institution and of any land to be taken or purchased for any new or existing institution. It must visit every institution under its supervision at least once a year and oftener if the gov- ernor so directs, and ascertain by actual examination and inquiry whether the laws relating to persons in custody or control therein are properly observed, give such directions as will insure correctness in the returns required, and use all necessary means to collect desired information. It must carefully inspect every part of each institu- tjon with reference to cleanliness, sanitary condition, number of patients in seclusion and restraint, dietary and other material mat- ters, and offer every patient an opportunity for interview with its visiting members and agents. The commission is authorized to develop a state-wide system of psychopathic hospital service. When so directed by the governor, the commission may assume and exercise the powers of the board of trustees of any state institu- 107 MASSACHUSETTS tion under its supervision in any matter relative to the conduct and management thereof. It has the same powers relative to state charges in institutions or other places, and of their property, as are vested in towns and overseers of the poor in the support and relief of paupers. The commission has power to investigate the question of the ^504 I9 9 ' insanity and condition of any person who is an inmate of any in- 9- stitution for the insane, public or private, or restrained of his liberty by reason of alleged insanity at any place within the common- wealth, and must discharge him, if he is not insane or can be cared for without danger to others, and with benefit to himself. All questions as to the sanity of inmates of the penal, reformatory and other institutions must be referred to and determined by the commission, except as is otherwise provided by law. The commission must prescribe the forms of application, medical " certificate, and order of commitment required by law in the com- mitment of all insane; keep records of all commitments and admis- sions, etc. If the commission has reason to believe that an insane " person is confined in an almshouse or other place at public charge or otherwise, it must cause application to be made to a judge for his commitment to an institution under its supervision. The trustees or superintendent of any institution coming under 37 - the supervision of the state commission must furnish it all the in- formation required and immediately notify it if there is any ques- tion as to the propriety of the commitment of any person received. The commission and the boards of trustees of the state institutions '3- underwits supervision must meet semi-annually for consultation. The commission on mental diseases may annually license any ^ r g^y ons suitable person to keep a hospital or private house for the care and ^ 4f I9l6> treatment of the insane, epileptic, feebleminded, and of persons addicted to the intemperate use of narcotics or stimulants. The applicant applying for a license must be a duly qualified physician with practical experience in the care and treatment of such patients. Licenses expire with the calendar year but may be renewed. For establishing or keeping such a hospital or private house without a license, unless otherwise authorized by law, the penalty is a fine of not more than $500. b. Institutional. Each state hospital is governed by a board seven trustees, five men and two women, all of whom are appointed ts of by the governor for terms of seven years. The trustees have charge *s. of the general interests of the institution. With the approval of Acts of 1915, the state commission on mental diseases they appoint the superin- * tendent and treasurer. With the approval of the trustees the super- MASSACHUSETTS 108 intendent appoints the assistant physicians. The commission on mental diseases establishes by-laws for the appointment of other officers as well as the regulations necessary for the conduct of the institution. In each institution receiving female patients and having more than two assistant physicians, one of these must be a woman. The trustees must provide for a monthly inspection of the fire apparatus and for the drill of the officers and employees in its use. (The law requires that each institution shall have proper fire escapes and fire apparatus and receive a written certificate of approval in regard to these matters from the proper inspector of fac- tories and public buildings.) The boards of trustees of the various institutions must maintain an effective inspection of their respective institutions; must ascertain whether the affairs of the institution are conducted according to law and according to the rules and regulations established by the com- mission on mental diseases; must carefully inspect every part of the institution as a board or by committee with reference to clean- liness and sanitary condition, the number of persons in seclusion and restraint, dietary matters and any other matter that may be considered worthy of attention; upon request of the commission on mental diseases must investigate any sudden death, accident or injury, whether self-inflicted or otherwise, and send a report to the commission; must personally hear and investigate the complaints and requests of inmates, officers or employees. At least two of the trustees must visit the institution each month, a majority of them quarterly and the whole board semi-annually, and they must make a written report to the commission on mental diseases whenever there are matters observed that need the attention of the com- mission. Trustees have access to all books, records and accounts pertaining to their respective institutions and must be admitted at all times to the buildings and grounds. They have power at any time to cause the superintendent or any officer or employee to appear before them to answer any questions or to produce any books or documents relative to the institution. Plans and specifications for the construction or substantial alteration of buildings, the site of any new building, the proposed taking or purchasing of any new land, and plans for the grading of grounds or substantial improvements at the institutions must be submitted to the trustees and they must report thereon to the commission on mental diseases within a time fixed by the com- mission. New work cannot proceed until such report has been made or until the time fixed by the commission has expired. 109 MASSACHUSETTS 2. CARE a. In state institutions. Worcester State Hospital, Worcester; established 1833; 1,535 beds. Boston State Hospital, Dorchester Center; established 1839; 1,610 beds. (The Boston Psychopathic Hospital, established 1912, 110 beds, is a separate department of the Boston State Hospital.) Mental Wards, State Infirmary, Tewksbury; established 1852; 731 beds. Taunton State Hospital, Taunton; established 1854; 1,315 beds. Northampton State Hospital, Northampton; established 1856; 970 beds. Grafton State Hospital, Grafton; established 1877; 1,900 beds. Danvers State Hospital, Hathorne; established 1878; 1,485 beds. Westborough State Hospital, Westborough; established 1883; 1,260 beds. Bridgewater State Hospital, State Farm; established 1886; 855 beds. (For insane criminals.) Foxborough State Hospital, Foxborough; established 1891; 360 beds. Medfield State Hospital, Harding; established 1896; 1,645 beds. Gardner State Colony, Gardner; established 1902; 785 beds. (For chronic insane.) Metropolitan Hospital, Waverley; established 1914. (Not yet opened.) b. In local institutions. The commonwealth has the care, con- te trol, and treatment of all insane, and no county, city, or town may ' establish or maintain any institution for the insane, or be liable for the board, care, treatment or act of any inmate thereof. c. In families. Harmless patients of any institution for the * insane other than those committed as inebriates may be placed at board in families by the commission on mental diseases or by the trustees of the institution. The commission must have all persons 73- boarded out by it visited by an agent once in three months, and those boarded out by trustees visited once in six months, by an agent of the commission. The trustees must have all persons boarded by them in families visited once in three months. The use of mechanical means of restraint may not be applied on any patient in any public or private hospital for the care or custody Acts ^f 1911, of the insane unless applied in the presence of the superintendent, or l - of a physician of the institution, or on his written order, which must be preserved in the records of the institution, and only in cases of extreme violence, active homicidal or suicidal condition, physical exhaustion, infectious disease, or following an operation or accident MASSACHUSETTS 110 Records. J. Who may commit the Certificate of physicians required. 30. which has caused serious bodily injury, except in cases of emergency- But every emergency case must immediately be reported to the superintendent or to the physician or assistant physician of the in- stitution, who must at once investigate the case, and approve or disapprove the restraint imposed. The records of all restraint must be kept in a book open for in- spection at all times by the trustees or other persons having control of the institution, the commission on mental diseases the governor and council, and members of the general court. Restraint also includes therapeutic and chemical restraint and confinement in a strong room, or seclusion in solitary confinement. The superintendent or head physician must keep personally under lock and key all implements or apparatus of restraint not in actual use. The above provisions do not apply to the prolonged bath, to the hot or cold pack, or to medication when used as a remedial measure and not as a form of restraint. Any one who knowingly violates this act is deemed guilty of a misdemeanor and may be fined not less than $50 nor more than $300 for each offense. 3. COMMITMENT a. Persons committed. All insane persons, except feebleminded, are entitled to admission to state institutions for the insane. Insane epileptics are committed to the Monson state hospital, an institution especially for that class. Provision is also made for the commitment of female inebriates to hospitals for the insane. b. Legal procedure in commitment. Judges of probate for the counties of Suffolk and Nantucket or a justice of a police, district or municipal court (except the municipal court of the city of Boston) within his county, may commit to any hospital or institution for the insane, whether public or private, designated by the state commis- sion on mental diseases, any person then residing in the county, who is a proper subject for treatment or custody. Except in the case of the absence or incapacity of the justice or in case of other emergency, no special justice of a police of the district court or municipal, may make a commitment. Commitment may not be made unless there has been filed with the judge a certificate of the insanity of the alleged insane person by at least two physicians, nor without an order signed by the proper judge, stating that he finds the person committed to be insane, and either that he has been an inhabitant of the commonwealth for six months immediately preceding the finding, or that provision satis- factory to the state commission on mental diseases has been made Ill MASSACHUSETTS for his maintenance, or that by reason of insanity he would be dangerous if at large. The order of commitment authorizes the custody of the insane person either at the hospital to which he is first committed, or at some other hospital to which he may bej^ransf erred. The judge must see and examine the alleged insane person if he deems it advisable to do so, and must certify to the residence of the person at the time of his commitment. The judge may call in a 3I - third physician when he deems it advisable. A physician making a certificate of insanity must be a graduate of a legally chartered medical school, have been in actual practice for three years since graduation and for the three years last preceding, and be registered in accordance with the laws of the commonwealth. His standing, character and professional knowledge of insanity must be satisfactory to the judge. The physician must have ex- amined the alleged insane person within five days of the certificate. A copy of the certificate, attested by the judge, must be transmitted to the superintendent of the hospital to which the insane person is committed, who in turn transmits copies to the state commission on mental diseases. A certificate bearing date more than ten days prior to the commitment of a person alleged to be insane is void. 32- No certificate is valid or may be received in evidence if signed by a physician holding an appointment, except in a consulting or advisory capacity, in the hospital for the insane to which the person is com- mitted. A statement containing facts in the form prescribed by the 33. state commission must be filed with the application and a copy sent to the superintendent of the institution. An order of commitment is void if the patient is not received at^ ts of the hospital within thirty days. Within two days after the reception of an insane patient, the Jj^j? superintendent must send notice of his commitment by mail to all^ ts o of persons whose addresses appear on the statement, or to any other '3. two persons whom the patient may designate. After hearing such evidence as he may regard as sufficient, judge may cause the apprehension of the alleged insane person if it is 34 necessary or proper to do so and place him in such custody or con- finement as he sees fit. The judge may summon a jury of six men to hear and determine gSSy whether the alleged insane person is insane. In such cases the 36. judge shall have the same authority as the supreme judicial court 39. to enforce the attendance of jurors and witnesses and to impose 38. fines for non-attendance. The verdict of the jury is final. The superintendent of any hospital for the insane may, without an Emergency order of a judge, receive and detain for not more than five days any 42. MASSACHUSETTS 112 Persons suffer- ing from certain mental disorders who are arrested. Acts of 1910, ch. 307- Temporary care pending commitment. Acts of 1909. 44' Acts of 1911, ch. 394. Temporary care. Acts of 1915, ch. 174. person whose case is certified to be one of violent and dangerous insanity, or of other emergency, by two physicians qualified as provided by law. Officers entitled to serve a criminal process or any member of the district police must upon the request of the ap- plicant or of the certifying physicians cause the arrest and delivery of such a person to the superintendent. The person applying for such admission must within five days cause the alleged insane person to be committed or removed from the hospital under a penalty of $50 and liability to the hospital for the expense incurred. If a person is found by two qualified physicians to be in such mental condition that his commitment to a hospital for the insane is necessary for his proper care or observation, he may be committed to a state hospital for the insane or to the McLean Hospital (a private institution), under such limitations as the judge may direct, pending the determination of his insanity. All persons suffering from delirium, mania, mental confusion, delusions or hallucinations who come under arrest or under the care or protection of the police of the city of Boston must be taken di- rectly to the Boston Psychopathic Hospital in the same manner in which persons afflicted with other diseases are taken to a general hospital. If the admitting physician at the hospital finds after examination that the person is suffering from delirium tremens or drunkenness the hospital need not admit him, but otherwise the hospital must admit, observe and care for all such persons until they can be committed or admitted to hospitals appropriate in each particular case. A person suffering from insanity or mental confusion, except delirium tremens and drunkenness, may not be placed in any jail or place of detention for criminals. If he has been so placed in a case of emergency he must be examined by a physician, given proper care and not be detained for more than 12 hours. Any person not so placed, except in the city of Boston (where all such persons are to be taken to the psychopathic hospital), must be cared for by the board of health of the city or town in which he is found, which must have him examined by a physician and committed to an institution, unless he recovers or is suitably provided for by relatives or friends. The superintendent of any public or private hospital for the insane may receive for temporary care, not exceeding ten days, any person suffering from mental disease, on the written appli- cation of any physician, member of the board of health or police officer in any city or town, an agent of the institutions registration department of the city of Boston, or member of the district police. The patient must be discharged, committed, or remain as a volun- tary patient, at the end of ten days. 113 MASSACHUSETTS Penalties are prescribed for wilfully conspiring to commit a person ^ a ^ t ^ ent unlawfully to an institution for the insane as well as for the ill- ^ ts 5 J I9 9> treatment or neglect of any patient on the part of the hospital authorities or employees. The relatives or friends of an insane person or the mayor and aldermen of the city or the selectmen of the town in which he lives may apply to the probate judge for the appointment of a guardian for him after due notice has been given. An examination by physi- cians may be had. Upon application of any of the same parties a temporary guardian may be appointed for an insane person by the probate court, with or without notice of hearing. c. Voluntary admission. The superintendent of any institu- tion to which an insane person may be committed may receive, any 45- person as a voluntary patient who makes written application and is mentally competent to make it. A voluntary patient may not be detained for more than three days after having, given notice in writing of his desire to leave the institution. Due notice must be 4 6 - give the commission on mental diseases of each case of admission of violent and of temporary and voluntary patients. d. Appeal from commitment. There is no provision for appeal f^jj ca i| on from an order of commitment. But any person may apply to a justice 78 - of the supreme judicial court at any time for the discharge of a person whom the applicant believes ought no longer to be confined as insane. The alleged insane person may be brought before the justice at the - hearing on a writ of habea's corpus. The case may be heard with or H | beas corpus without a jury, and if it is found that the person is not insane, or not dangerous, and ought no longer to be confined, he must be discharged. e. Cost of commitment. The expenses attending the commit- ting and delivering of an insane person, epileptic, dipsomaniac drug habitue to a state institution are chargeable to the county in which commitment was made. If commitment does not result, the expenses incurred in seeking commitment are likewise chargeable to the county. All such expenses must be refunded the county paying them by the county of which the person in question is an inhabitant. But if the person was an inmate of a state institution at the time of his commitment or denial of application for the same, the expenses must be repaid by the county of which he was an in- habitant at the time of admission or by the county from which he was sent if he is without legal residence in any county. The expense of returning a patient on temporary leave, must be paid by him or by his guardian, relatives or friends, if of sufficient ability, or may be paid by his county if a new commitment is necessary. The ex- penses of committing a pay patient are to be borne by the applicant, or by a person in his behalf. MASSACHUSETTS 114 Woman at- tendant. Acts of 1909, ch. 504. 47- By the governor. 68. By the com- mission. Acts of 1917, ch. 131. 4. CONVEYING PATIENTS TO THE HOSPITAL If a woman is committed to an institution under the supervision of the state commission, the committing magistrate must, unless she is accompanied by her father, husband, brother or son, designate a woman to be an attendant to accompany her thereto. 5. TRANSFER OF PATIENTS The governor may at any time cause an inmate of a state institu- tion under the supervision of the commission on mental diseases to be removed to another such institution as the circumstances of the case may require. The commission on mental diseases may transfer any inmate to or from any institution under its supervision; but no person may be confined or transferred as insane unless duly committed' by the court, or be confined in or transferred to the Bridgewater state hos- pital unless the inmate has been a criminal and vicious in his life. The commission may remove any pauper inmates to any county, state or place where they belong and may enter into agreements with commissioners of. other states for the transfer of inmates from one state to the other. The commission may not transfer any person to or from a private institution except upon the application of the superintendent of such institution, nor transfer any voluntary inmate except with his written consent. 6. PAROLE AND DISCHARGE OF PATIENTS Parole by commission. Acts of 1909, ch. 504. 74- tendent. Acts of ch. 48. The state commission may permit a patient boarded in a family as an insane person to leave custody temporarily in charge of his guardian, relatives, friends, or himself for a period not exceeding one year, and may receive him again into custody when returned by the guardian, relatives, or friends, or upon his own application within this period without a new commitment. By the superin- The superintendent may permit any inmate to temporarily leave the institution in charge of his guardian, relatives or friends or by himself for a period not exceeding twelve months and may receive the inmate when returned. He may require as a condition of the leave of absence that the person in whose charge the inmate is left, must report the condition of the inmate. The superintendent or the person in whose charge the inmate is left may terminate the leave and request the return of the inmate to the institution. The superintendent of any public or private institution, when au- thorized by his trustees, by the state commission on mental diseases, or on a written application; or a judge of probate for the county in which the institution is located or in which the inmate has his resi- dence, or a justice of the supreme judicial court, after due notice Discharge of patients. Acts of 1909, ch. 504. 76. 115 MASSACHUSETTS to the superintendent, trustees, or state commission, may discharge any inmate if it appears that he will be properly cared for or that his detention is no longer necessary for his own welfare or the safety of the public. If the guardian or any relative of an inmate opposes the discharge, it may not be made without written notice to the person opposing it. The provisions of this section do not apply to persons committed by a court. No unrecovered inmate who is known to have committed orP^serous inmates. attempted violence to others, or who is likely to become dangerous, ? 7 - may be discharged or given leave of absence without the approval of the commission on mental diseases. The commission may, if it can not agree with the opinion of the superintendent in the case, file a petition for instructions in the probate court of the county in which the institution is situated, and may have the patient examined by one or more experts in insanity. Pauper insane must upon discharge be provided with suitable ^ tj ^ ne clothing and money not exceeding $20, at the discretion of the trus- 8l - tees. Inquiry must be made in regard to the future situation of every patient about to be discharged. No person may be discharged or paroled temporarily unless one of the hospital physicians has ex- amined his mental condition within forty-eight hours of his departure. 7. COST OF MAINTENANCE All indigent insane are maintained at the expense of the state. ^^J^g by The trustees may make contracts for the support of inmates at a sum not less than six dollars a week. The price for the support of *** of inmates not under orders of the court must be determined by the Recover y- commission at a sum not exceeding six dollars a week and may be recovered from the person or relatives liable for the support, if of sufficient ability. The action for recovery must be brought by the attorney general. Any person making payment, may bring an action for recovery or contribution from persons liable for the sup- port of an inmate. Any guardian or conservator who has property of an inmate ^SJj s of exceeding two hundred dollars in value who fails to make payment Acts of 1917, for the support of his ward in an institution within three months after receipt of a bill, may be removed upon the application of the attorney general. 8. CRIMINAL INSANE If a person charged with any crime is at the time appointed f or J e ^[^ nt trial or sentence, or prior thereto, found to be insane, or of such ? f criminal mental condition that his commitment to a hospital for the insane Acts of 1917, is necessary for the proper care and observation pending the deter- MASSACHUSETTS 116 Commitment of insane felons. Acts of 1909, ch. 504. 104. Commitment of insane found in prisons. 105. Acts of 1917, h. 4 6. mination of his insanity, the court may commit him to a state hos- pital for the insane and must employ one or more experts in insanity to examine him. When, in the opinion of the trustees and superintendent of the hospital, he is restored to sanity, he must be returned to the custody from which he was removed, and held in accordance with the terms of the process by which he was originally committed. If a person indicted for murder or manslaughter is acquitted on the ground of insanity, the court must order him committed to a state hospital for the insane during his natural life, and he may be discharged by the governor with the advice and consent of the coun- cil, when they are satisfied after an investigation of the state com- mission on mental diseases that it may be done without danger to others. Such a patient may be permitted by the superintendent, with the approval of the governor and council, to leave the hospital temporarily. The commission on mental diseases must designate two experts in insanity to examine, together with trie prison physi- cians, the prisoners in the state prison or the Massachusetts reform- atory or the reformatory prison for women, who are alleged to be insane, and report the result to the superior court of the county in which the prison is situated. The court may, if it considers the prisoner insane, order his removal, if a male prisoner, to the Brfdge- water State Hospital; and, if a female, to one of the state hospitals for the insane, there to be kept until, in the opinion of the superin- tendent and the trustees of the hospital, he or she should be returned to prison. If a prisoner under sentence in a jail, house of correction or prison other than those mentioned in the preceding paragraph, appears to be insane, the physician in attendance must make a report to be transmitted to the proper judge, who may order the prisoner removed to a state hospital for the insane. If a person so removed is restored to sanity, he must be returned to the prison or house of correction from which he was removed, to remain pursuant to the original sentence. 117 MICHIGAN Authorities: Howell's Michigan Statutes, 1913 Laws of Michigan, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities and corrections composed of four residents of the state, appointed by the governor for terms of eight years. The governor is ex-officio a member of the board. The members of the board, or one of their number, or their secretary, must at least once a year visit and inspect state and local charitable and correctional institutions to ascertain their condition and management. They have authority to administer oaths and to examine any person connected with the institutions. They serve without pay and make a biennial report to the governor. b. Institutional. Each of the state hospitals for the insane under a board of trustees of six members appointed by the governor 3645. for terms of six years and subject to removal by him. The psycho- pathic hospital is under the direction of a board of trustees com- posed of four members selected from the boards of trustees of the state hospitals for the insane and an equal number of the members 3853. of the board of regents of the state university. The state hospital *S39i. for the dangerous and criminal insane is controlled by a board of trustees consisting of three members. The government and exclusive control of the several hospitals is vested in the several boards of trustees, who serve without compensa- tion. The boards have control of all the property, exercise general supervision, appoint medical superintendents, treasurers, and other employees, determine the salaries of employees, and establish rules. The boards of trustees meet jointly at least twice each year at the different hospitals to adjust all questions that may arise pertaining to their institutions; and the joint boards may transfer patients from one hospital to another if it becomes necessary or desirable. The medical superintendent of each hospital, subject to the regula- superintend- tions established by the board of trustees, has general oversight of 3649. the institution, nominates co-resident officers and appoints other assistants. The Wayne county hospital for the insane is under the manage ment of the board of county superintendents of the poor, consisting 3694- of seven members elected in the same manner as other county officials . iion. MICHIGAN 118 2. CARE a. In state institutions. Kalamazoo State Hospital, Kalamazoo ; established 1848; 2,250 beds. Pontiac State Hospital, Pontiac; established 1873; 1,600 beds. traverse City State Hospital, Traverse City; established 1881; 1,700 beds. Ionia State Hospital, Ionia; established 1883; 518 beds (for crimi- nal and dangerous insane). Newberry. State Hospital, Newberry ; established 1895; 1,000 beds. State Psychopathic Hospital, University of Michigan, Ann Arbor; established 1906; 60 beds. b. In local institutions. Wayne county maintains an institu- tion for the insane, known as Eloise hospital at Eloise. Patients are transferred from county to state charges as in the state hospitals, and Eloise hospital maintains some 600 state patients. A few in- sane persons are cared for in the county infirmaries. 3. COMMITMENT perlonl f a * P ersons committed. All insane residents of the state, not 3653. feebleminded or epileptic, are entitled to admission to the state hospitals. The following classes of patients may be admitted to the state hospitals for the insane: (1) public patients, maintained at the expense of the state; (2) private patients maintained without expense to the state; (3) voluntary patients who are not insane, and are maintained either at private or state expense. No ^"/o Sidents ' ^ non-resident may be admitted to a hospital for temporary care, pending his return to his home; and boards of trustees must remove any person admitted to a hospital who has not acquired a legal settlement in the state to the country or state to which he belongs. Jobat^court ** Legal procedure in commitment. The father, mother, hus- 9656. band, wife, brother, sister or child of a person alleged to be insane, or the sheriff, or any superintendent of the poor, or supervisor of any township, or any peace officer within the county in which an alleged insane person is found, may petition the probate court of the county for his admission to a hospital for the care of the insane. The petition must contain a statement of the facts upon which the al- Hearing. legation of insanity is based. The court must fix a day for a hearing and appoint two reputable physicians to make the required examina- ^ on ^ ^c alleged insane person, whose certificate must be filed with the court on or before hearing and served personally, at least twenty- four hours before the hearing, upon the person alleged to be insane, and if made by a sheriff or peace officer, also upon the father, mother, husband, wife or some one next of kin of the alleged insane person, 119 MICHIGAN residing within the county, and upon such of the relatives outside of the county and within the state as may be ordered by the court, and also upon the person with whom the alleged insane person may re- side. The court may dispense with personal service or may direct substitute service to be made upon some person to be designated by it. In such cases, the court must appoint a guardian ad litem to represent the insane person at the hearing. The court must in- investigation stitute an inquest as to. the alleged insanity of the person, and in all cases take proofs in writing of the financial circumstances of his relatives legally liable for his support, and as to the person's legal settlement. If no jury is demanded, the probate court determines the question of the sanity or insanity. If the court deems it neces- sary, or if the alleged insane person, or any relative, or other person concerned demand it, a jury must be summoned to determine the J uf y- question of insanity. If it appears upon the certificate of two legally qualified physicians to be necessary, the court may order the alleged insane person to be placed in the custody of some suitable person or Commitment, to be removed to the state hospital of the district in which he resides, or to any hospital, home or retreat pending the proceedings for commitment, but not for more than thirty days, except by special order of the court. The alleged insane person has the right to be present at the hearing. No person may be admitted to an insti- tution under order of commitment after the expiration of thirty days from its date. The board of trustees of the Traverse City Hospital may prescribe ^aws of wi rules and regulations for the admission of patients. Persons who are mentally disordered but regarding whom there is ^. doubt as to their being insane may be committed, under the rules st * of the trustees, to the psychopathic hospital for observation for period not exceeding thirty-five days. No resident of the state may be held as a public or private patient J^' in any hospital, public or private, or in any institution for the care or statutes, treatment of the insane, except upon certificates of insanity and an order for admission; provided, that a person adjudged to be so ad- inebriates, dieted to the excessive use of intoxicating liquors or narcotics as to be in need of medical treatment and care, for whom a guardian has been appointed, may be restrained by the guardian in some suitable hospital or asylum; provided, further, that a judge of any court of Temporary record or police justice of any city or county may, upon a certificate of two legally qualified physicians, authorize any superintendent of the poor or peace officer of the city or county to remove to a hospital or other place of detention, a person believed to be insane against whom no proceedings have been instituted and detain him until proceedings are instituted in the probate court. The period of such MICHIGAN 120 temporary detention must not exceed five days, unless by order of the probate court. insanfty* 1 " f Certificates of insanity must be made by two reputable physicians, 3655. under oath, appointed by the probate court of the county in which the alleged insane person resides. The physicians must be per- ftySns 5 rnanent residents of the state, duly registered, have the qualifica- tions prescribed by the laws of the state for the practice of medicine and surgery, and may not be related by blood or marriage to the insane person nor to the person applying for the certificate. Their qualifications must be certified by the clerk of the county in which they reside. Neither of the physicians may have any interest directly or indirectly in the institution to which it is proposed ta commit the person. The physicians must make a personal ex- fxamination amm ation of the alleged insane person enabling them t'o form an required. opinion as to his sanity or insanity, and no certificate of insanity may be made except after personal examination. Certificates of insanity must contain the facts and circumstances upon which the opinion of the physicians is based, and show that the condition of the- person examined requires his care and treatment in a hospital for the insane. A copy of the physician's certificate together with a copy of the application for commitment of the patient must accompany the order of commitment. C rivate tment to When the state hospitals are unable to receive patients for lack of h 3 S 66? ls ' room, the court is authorized to order the admission of any person who has been adjudged to be insane as a public patient to any private hospital in the state with which a contract for the care and maintenance of public patients has been made. If relatives or friends request it, the court must order his commitment to a private institution for the insane. Seized c * Voluntary admission. All residents of the state who are 3669. afflicted mentally, or with serious nervous disability, but who are not insane, may be admitted to the hospitals as voluntary patients, at the discretion of the medical superintendent and under special agreement, when there is room. No order of probate court is necessary for such admission. In the case of any voluntary patient, and'court a cer tificate, signed by two reputable physicians having the qualifi- cations prescribed by law, stating that the person needs hospital treatment but is not insane, must be presented to the medical superintendent. The certificate must be accompanied by a cer- tificate from the county clerk. Voluntary patients may be dis- charged at any time by the medical superintendent. Indigent patients may be admitted as voluntary patients. If any voluntary Commitment, patient in any hospital of this state is believed to be insane, he may be admitted to a hospital as insane by order of the probate court 121 MICHIGAN in the county in which he lives after the prescribed legal pro- ceedings. d. Appeal from commitment. Anyone in custody as an insane Writ of habeaa person in any hospital, home or retreat, is entitled to a writ of habeas 3675- corpus upon a proper petition to the circuit court of the county of which the hospital, home or retreat is situated, made by him or some friend in his behalf. e. Cost of commitment. The expenses of committing a person to JJjjJ,^ the a hospital, including the cost of transportation, necessary clothing, 3679- etc., are paid by the county of which the person is a resident, if he has no estate out of which it can be collected. 4. CONVEYING PATIENTS TO THE HOSPITAL The judge of probate may appoint a proper person to convey an f t t^| nt insane patient to the hospital. A female patient must be accom- 3 68 - panied by her father, brother, husband, son or a female attendant. 5. TRANSFER OF PATIENTS The medical superintendent of any hospital for the insane must ^dent supe " n " apply to his board of trustees for authority to transfer any insane 3667. person or person under treatment and supported by the state who exhibits dangerous or homicidal tendencies to the hospital for the dangerous insane. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of a hospital may grant a parole to a private flu 1 ^ patient for not more than thirty days under conditions prescribed by the board of trustees. Medical superintendents may discharge patients who have re- Discharge by i 11 i t . i . L i 11- 11- superintendent. covered as well as those who are not detnmental to public welfare. 3673. When a superintendent is unwilling to discharge an unrecovered patient upon request, the probate court of the county from which By probate the patient was admitted into the hospital may, after a hearing has been accorded the superintendent, direct the discharge of the patient, upon such security as the court may require. A patient who has been discharged by the medical superintendent may, with his ap- proval, be readmitted to the hospital under the original order of admission at any time within six months after the date of the dis- charge, but thereafter only upon a new adjudication of insanity and order for admission. No patient may be discharged without suitable clothing, and C1 jgj*- money not exceeding $25 for his necessary expenses until he can reach his relations or friends, or his employment to earn a sub- sistence. MICHIGAN 122 Petition for restoration to" sanity. 3674- Private patients. 3657. Public patients. 3659- 3660. Guardian. 3659. Persona ac- quitted of crime. 15408. Persons con- victed of crime. 15409. When any person adjudged insane is discharged from custody and not again received into any hospital, home, or retreat, petition may be presented to. the court for an order declaring him restored to soundness of mind. The court must fix a time for hearing the case. The testimony of at least two reputable physicians, establishing the sanity of such person, is required. (See 3. d. Appeal from commit- ment; habeas corpus.) 7. COST OF MAINTENANCE If a bond for the support of an insane person is executed by at least two persons approved by the probate court, together with the required advance payment toward his support, his admission must be ordered as a private patient; otherwise, as a public patient. The county in which the proceeding is had is liable to the state for the support of the patient until the bond and advance payment are delivered to the medical superintendent. At the request of the medical superintendent, the court must require the persons executing the bond to justify their responsibility anew or order that a new bond be given, and unless this be done, the insane person is to be regarded as a public patient. In case the admission of the insane person is ordered as a public patient, then the county of which he is a resident is liable to the state for the support of such patient for one year. If a public patient has an estate out of which the state may be reimbursed for his maintenance, the court must direct such payment out of his estate for the cost of his maintenance at the hospital as it deems just. The court on making an order of com- mitment may appoint a temporary guardian for an insane person until a guardian both of his person and estate can be regularly appointed. 8. CRIMINAL INSANE When a person accused of crime has escaped indictment, or has been acquitted upon trial, upon the grounds of insanity, the court must inquire whether his insanity in any degree continues, and, if it does, must order him to be sent to the state hospital for the dangerous insane. All persons who are adjudged insane, and pre- viously have been convicted of crime, or at the time of such ad- judication are in confinement on a criminal charge, must be admitted to this hospital. If any such person has been admitted to any of the other hospitals, the medical superintendent thereof may have him removed to the above hospital. All persons who are adjudged insane, and who before such ad- judication have been convicted of crime or are patients in the state hospital for the criminal insane, or who at the time of such adjudi- 123 MICHIGAN cation are confined on a criminal charge, must be admitted to the state hospital. If any such person is admitted to any of the other hospitals the medical superintendent may cause him to be removed to the state hospital for the dangerous insane where he shall be received and admitted as a patient. When a physician of the house of correction, reformatory, or state p^*^ f e e r r s of prison certifies to the officer in charge that an inmate is insane, the 15416- officer if satisfied that the inmate is insane must cause him to be transferred to the state hospital for the criminal insane. When recovered, he must be returned to the institution from which he came. If the patient continues insane after the expiration of his sentence, application must be made within five days to the judge of probate for the patient's commitment and retention in the hos- pital; but such a convict must be delivered to friends if they give surety approved by the governing board for the patient's mainte- nance and good behavior. 124 Board of control. General statutes. 4001. 4003. 4009. 4016. 4021. 4036. 4018. Superintend- ent. 4009. MINNESOTA Authorities: General Statutes of Minnesota, 1913 Laws of Minnesota, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control is composed of three members, appointed by the governor, for terms of six years. Each member of the board receives a salary of $4,500 per annum and must devote all his time to the duties of the board. The board of control has exclusive management of the hospitals and asylums for the insane, including full authority in all financial matters. The board may appoint a purchasing agent for each institution, and must appoint a chief executive officer for each, subject to removal for misconduct or incompetency. The board determines the compensation of all officers and employees, except when it is fixed by law, and prescribes regulations in regard to the duties of the employees under its control and methods of accounting and keeping records. Each hospital and asylum for the insane must be visited by a member or the secretary of the board once in each month. The board may appoint a competent woman to visit and report upon such institutions. The board must prepare for the use of the legislature biennial estimates for appropriations necessary for the support of the hospitals and asylums and for extraordinary ex- penditures for buildings and other improvements. It must keep records showing the residence, sex, age and other facts in regard to each patient in each of the institutions under its control, together with full information about their condition upon discharge and other similar information. To secure uniformity in the examination and commitment of the insane, the board prescribes the forms of blanks that are used. The board must gather and disseminate information about the best methods of caring for the insane, encourage scientific investiga- tion in the hospitals and publish the results. The board is required to make a biennial report to the governor in detail. b. Institutional. There are no local boards of trustees. The superintendent of each hospital or asylum has authority to appoint and discharge all assistants and other employees required for the management, subject to the consent of the board of control. Each superintendent is required to make an annual report in prescribed form to the board of control. 125 MINNESOTA 2. CARE a. In state institutions. St. Peter State Hospital, St. Peter; established 1866; 1,300 beds. Rochester State Hospital, Rochester; established 1877; 1,200 beds. Fergus Falls State Hospital, Fergus Falls; established 1890; 1,600 beds. Anoka State Asylum, Anoka; established 1900; 900 beds. Hastings State Asylum, Hastings; established 1900; 760 beds. Willmar State Asylum, Willmar; established 1917; 100 beds. In connection with each of the first three hospitals there is a detention hospital in which patients are received for voluntary treatment or for examination before final commitment. Insane persons are received also at the Hospital Farm for Inebriates at Willmar. The criminal insane, insane criminals, and other danger- 4102. ous insane persons are cared for at the asylum for the dangerous insane, a building maintained in connection with the state hospital at St. Peter. b. In local institutions. Practically no insane are maintained at the county poorhouses. c. In families. Whenever the superintendent of a hospital re- . Boardin e ut ports to the board of control that any insane person under his charge 4096. is incurable or not likely to be further benefited by treatment, that he may be safely cared for in a private family, and that his own family is not able to support him, the board may authorize the superintendent to place him in a suitable private family, at an ex- pense not exceeding $3 per week. The superintendent, or some one delegated by him, must visit such patient once in three months, and may at any time direct his return to the institution. 3. COMMITMENT a. Persons committed. All insane persons who have a settlement * in a county, town, city or village, must be admitted to an institution 4046 for the insane, except that the board of control may authorize ad- mission when the residence is not ascertained or when circumstances make admission advisable. When application is made to a judge of probate for the admission to any hospital or asylum, and he finds that the person by whom the application is made has no residence or that his residence can not be ascertained, he must report to the board and may recommend that the person be admitted notwith- standing. If the board finds that the person has a legal residence in another state, it may have him returned to it. b. Legal procedure in commitment. When any person who is a JjJJ^ resident of the state is supposed to be insane, any relative, guardian, <^344 or reputable citizen of the county in which the person resides or is found may file a certified petition in the probate court. The court MINNESOTA 126 may issue a warrant directing the person to be brought before the court for examination. Examination. The county attorney, upon an order from the court, must appear in behalf of the person to be examined, and the court must appoint two licensed physicians, who with the probate judge constitute a board to examine the person and determine as to his insanity. If the person is obviously insane, the probate judge may dispense with the board of examiners, and may hear and determine the matter, if the county attorney consents. Report. When the examination is completed, the board must determine whether the person is insane, and report the proceedings to the court commitment. U p O n forms authorized by the board of control. If the person ex- amined is found to be insane, the court must commit him to the custody of the superintendent of the proper state hospital or to the superintendent or keeper of any private licensed institution for the care of insane persons. " The probate judge, with the approval of the county board, may provide a place of temporary detention for the insane, making the necessary contracts, but may not erect a hospital for the purpose. All necessary expenses of such temporary detention shall be paid by the count y- When the probate judge is unable to act, all of his duties may be performed by the court commissioner. S> r urt rs f the When the health or condition of a child under 17 years of age scutes requires it the court may cause the child to be placed in an institution 7162. f or treatment and special care. todeTendon ts Each person found to be insane, except the criminal insane, may hospitals. be committed to the proper detention hospital, to be kept and treated until the superintendent determines and certifies either that he is not insane or that he is a fit subject for a state hospital for the insane. If he is found to be sane, he must be discharged, as provided by law in other cases. If after a reasonable time, the superintendent deems him a fit subject for a state hospital or asylum, and so certifies to the state board of control, it must transfer him to a hospital or asylum. omunitted ^ ny husband, wife, parent, son, daughter or guardian, believing 4086. hi s wife, husband, father, son, daughter, mother, brother, sister or ward, to be afflicted with mental disease for which such person should be treated at a detention hospital, may apply to the judge of probate of the county in which the patient is a resident for the appointment of a board of three physicians, one of whom must be the family physician, if there be such. The judge of probate of the county must immediately appoint such board to determine whether the patient is in need of treatment at a detention hospital; and if a majority of the board so determines, the patient may be placed in the detention hospital by the relative who must sign the necessary 127 MINNESOTA application therefor, in the same manner and under the same re- strictions and provisions as for detention in the hospitals for the insane. When information is filed with any judge of probate that a 4 87< resident of his county is in need of treatment at a detention hospital, he must make proper investigation, and, if it substantiates the in- formation filed, at once appoint a board to determine whether the proposed patient is in need of the treatment, and if he so determines, the patient must be placed in a detention hospital under the same restrictions that govern voluntary admissions. At each city or village where a state hospital for the insane is c^mfiiS* 1 located, a state hospital commission, composed of three reputable 4089. persons, at least one of whom is a duly qualified physician, must be appointed by the judge or judges of the district court of the county in which the detention hospital is situated, to hold office for two years. The commission has power to examine alleged insane persons and determine whether they are insane. The state hospital com- 4090. mission must meet at the detention hospital as often as may be requested by the superintendent thereof, but not oftener than twice each month, except in cases requiring immediate action. c. Voluntary admission. Any person believing himself to be Ap 4 p ^ tion - afflicted with mental disease and desiring to receive treatment at a detention hospital may voluntarily place himself therein. Before being admitted, he must make and sign a written application as provided by the board of control. When an application has been signed in presence of two witnesses, not officers or employees of the detention hospital and delivered to the superintendent, the ap- plicant may be received into the hospital for treatment. The super- intendent is authorized to continue the detention of such a patient when in his judgment the condition of the patient requires it. Should the patient demand his release from the hospital and it is deemed unsafe, the superintendent must within three days call in the state board of control to take charge of the case and deter- mine whether the patient is insane. If adjudged insane, he must be committed to the hospital. If found to be sane, he must be required to leave the hospital. Any person who is defective and desires to receive treatment at a f e e e " a d s m sk.n. state institution, may voluntarily make application to the state ^ S 4 | I917> board of control for admission under the rules of the board. 2 - The superintendent of the institution may detain any voluntary patient in the same manner as other patients, unless the person is patients ordered discharged by the court. If the person demands his release and the superintendent deems it unsafe to discharge the person, a petition for commitment must be filed in the probate court by the superintendent within three days. MINNESOTA 128 8a8 4 . Laws of 1917, ch. 344- 14. By the board. General Statutes. 4037. **' A PP eal fr m commitment. Every person restrained of his liberty may prosecute a writ of habeas corpus. Application for such writ must be by petition to the supreme court, or to the district court of the county within which the petitioner is detained. e. Cost of commitment. The expenses of the examination and commitment of an insane person are chargeable to the county of which he is a legal resident. In case of dispute, the board of control determines the question of residence. 4. CONVEYING PATIENTS TO THE HOSPITAL It is the duty of the sheriff of the county, together with such at- tendants as shall be designated by the judge of probate, to convey an insane patient to the hospital. 5. TRANSFER OF PATIENTS The board of control may transfer patients from one hospital or asylum for the insane to another or to and from the school for feeble- minded. 6. PAROLE AND DISCHARGE OF PATIENTS ?endent superin ~ Whenever he deems it advisable, the superintendent may allow 4s>7. a patient to be absent on parole for a period not exceeding six months. The order of commitment remains in force until he is 4022. legally discharged, and he may be recalled at any time. The state board of control must so far as possible exercise supervision over paroled patients and may for that purpose appoint one or more state 4023- agents. It may also appoint suitable persons in any part of the state for the same purpose. No one may be appointed as such agent who has not had at least a year's experience in caring for patients at a hospital for the insane. The superintendent may discharge any patient certified by him to be recovered, except those charged with or convicted of some criminal offense. In all other cases, patients must be discharged by the board of control. When discharged, a patient must be provided with sufficient money to defray his expenses to his destination. > When in the judgment of the superintendent of the detention hospital any patient, either voluntary or otherwise, has recovered, he must be required to leave the institution. If the superintendent is of the opinion that the patient is insane and that longer treatment in the detention hospital will be of no benefit, he must report the case to the state hospital commission. If adjudged insane by this commission, the patient must be committed as provided; if adjudged sane, he must be required to leave the institution. Any person alleged or found to be insane may be paroled in the care of relatives or friends, but the probate judge, or the superin- 4098. From detention hospitals. Laws of 1917, ch. 344. 12. 129 MINNESOTA tendent if the person has been committed to a hospital, may require a bond from them for the care and safe keeping of the person; but no person charged with or convicted of a crime shall be so paroled. Whenever any person committed to a hospital for the insane under J 3- this act is discharged or transferred to another institution, the superintendent must so notify the probate judge of the county from which the person was committed. 7. COST OF MAINTENANCE Whenever a person committed by a probate court has been re- c ^_ 394< ceived by a state hospital, the judge or clerk of the court must notify the board of control, sending a copy of the commitment proceedings. The superintendent of the hospital must investigate into the estate of every patient received, also that of the relatives or guardian, and report to the board of control. It is the duty of the judge of probate and county attorney to 3 ~ inquire fully into the property and estate of persons committed and of persons liable for support, and to report, with recommendations as to the extent the estate or relatives should be held liable, to the board of control. For the maintenance of each inmate of a state institution for the 4 * insane the state has a valid claim of $10 a month against the estate of the patient, or against the spouse, children, and parents in the order named. If it deems it advisable, the board may relieve the 6- estate and the relatives from a portion or all of the liability. The board may bring suit against the estate or relatives if payment is not made within thirty days after demand. The board is fully empowered to investigate the estates of persons 8 * liable for the support of inmates of state hospitals. If the board is unable to collect, the prosecuting attorney of the proper county shall, when directed by the attorney general at the request of the board of control, collect or bring suit in the name of the state. Any patient or his friends or relatives may pay the full cost of I0 ' maintenance or any portion of the cost of maintenance in excess of the minimum charge of $10 a month. If a deceased patient leaves no spouse, children, grandchildren, parents, the state may support a claim for maintenance against his estate at the rate of $120 a year for the time he was a patient, credit being allowed for any sums that may have been paid as well as for time away from the hospital on parole. 8. CRIMINAL INSANE When any person under indictment or information before or during trial is found to be insane, an idiot, or an imbecile, and to have 10 MINNESOTA 130 homicidal tendencies, the court in which the indictment or informa- tion is filed must commit him to the asylum for the dangerous insane there to be kept and treated until he recovers, when he must be returned to the court from which he was received. Whenever any person confined in the state prison or any other penal institution is alleged to be insane, the warden must notify the state board of control, which must have the prisoner examined by the probate court of the county where he is confined. In case he is found insane, he must be transferred by the order of the court to the state asylum for the dangerous insane. If, in the judgment of the super- intendent, his sanity is restored before the period of his commitment to the penal institution has expired, he must be removed by the state board of control to the institution whence he came, and there com- plete the period of his sentence. 131 / MISSISSIPPI Authority: Code of Mississippi, 1906 i. ADMINISTRATION AND SUPERVISION a. General. Mississippi is without a state board having general supervision or control of charitable institutions. The state hospitals for the insane are under the control management of a board of trustees of five members, of whom at least three must be physicians, appointed by the governor for terms of two years. The governor is ex-officio president of the board. The board must visit each hospital twice a year, and the gov- C 3 d 3 e i a . ernor, or the chairman of the board, or a majority of the board, may order a visitation at any time, but without making their coming known to the authorities of the hospital in advance. At each visita- tion the trustees must examine the hospital register showing the diagnosis of the case of each patient made by the superintendent, if the patient was admitted to the hospital since the last visitation. They must examine the journal of the daily treatment of each pa- tient kept by the head nurse of each ward, and examine each patient. They must inquire into the competency and efficiency of all ap- pointees and employees and make full report in writing to the gov- ernor, with recommendations which they consider will improve the management and the condition of the patients. They may order the dismissal of an employee without further inquiry, but in the case of an appointee must give him a hearing before dismissal. b. Institutional. The superintendent of the hospital, who must Su e P intend - be a skilled physician, is appointed by the governor for a term of four 3ig6 ' years. The governor may remove him for proper cause. 2. CARE a. In state institutions. Mississippi State Insane Hospital, Asylum; established 1855; 1,550 beds. East Mississippi Insane Hospital, Meridian; established 1889; 600 beds. Both hospitals are required by the statutes to provide special wards for the negro insane. b. In local institutions. The board of supervisors of each county is responsible for the maintenance of the indigent insane who can not be received into the state hospitals or who are harm- less incurables, and may provide for them in the poorhouses which are under their control. The supervisors must also furnish tem- porary care of insane persons pending an inquest. MISSISSIPPI 132 3216. Persons ex- cluded. Writs of lunacy. 3219. Petition. Hearing. Jury. 3220. Arrest. Confinement. 3228. Admission of persons not adjudged insane. 3227. Habeas corpus. 2445- 3. COMMITMENT a. Persons committed. All insane persons, who are bona fide residents of the state and have not been brought into the state as insane within five years, and the latter in special cases by the consent of the governor, must be admitted to the state hospitals free of charge. Mere idiots, fools, and non-curables, who are not danger- ous, are excluded from the hospitals. b. Legal procedure in commitment. The chancery courts have jurisdiction of writs of lunacy, to be exercised by the clerks at any time, subject to the approval of the court. Any relative of a lunatic, or insane person, may have him so adjudged; but if his relations and friends neglect or refuse to place him in an insane hospital, and per- mit him to go at large, the clerk of the chancery court must, on the application in writing and under oath of any citizen, direct the sheriff by a writ of lunacy to summon the alleged insane person to contest the application, and six freeholders to sit at the hearing. The result of the inquisition must be returned to the clerk. The jury must be charged by him to make due inquest (the particulars being prescribed by law). If the person is adjudged a lunatic or insane by the jury, or a majority of its members, and the jury finds that he should be confined, the clerk must direct the sheriff to arrest him and place him in one of the insane hospitals if there is a vacancy, and, if not, to confine him in the county jail pending such vacancy. The superintendent must obtain all the available facts relative to the insanity of each patient admitted on an adjudication of insanity; and the board of trustees must prescribe suitable regulations in regard thereto. c. Voluntary admission. On application for admission to an in- sane hospital made on behalf of an insane person who is a resident of the state, the superintendent and trustees may admit him to the hospital, although he had never been adjudged insane, and, if the person be in fact insane, they have authority to detain him. Before his admission, the person making the application must present to the superintendent a sworn certificate from two licensed, practicing physicians, and one respectable citizen who is personally acquainted with the alleged insane person, all of whom must be residents of the same county in which he resides. Upon receipt of such application and certificate, the superintendent must forward to the physicians blank forms to be filled out giving the history of the patient, form of insanity, and such other information as may be required. d. Appeal from commitment. The writ of habeas corpus extends to all cases of illegal confinement or detention Sy which any person is deprived of his liberty, or by which the rightful custody of any 133 MISSISSIPPI person is withheld from the person entitled thereto, except in cases expressly excepted. e. Cost of commitment. The costs of an inquest and the removal 32 "- to and from the hospital are to be paid by the estate of the insane person, and if he have none, by the persons required by the pauper laws to support him. The county of the legal settlement of an in- sane person is liable for all the expenses incurred and paid by another county. 4. CONVEYING PATIENTS TO THE HOSPITAL It is the duty of the sheriff to place persons adjudged insane in Dut y ot sheriff - one of the hospitals if there is a vacancy; if not, to confine him in the county jail until there is room. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS A patient who is found to be incurable but harmless, and who Di |^" ge ' can properly be cared for outside of the hospital, and a patient who has recovered, must be discharged. When a patient is restored to reason, the superintendent of the hospital may furnish him trans- portation to his home and make requisition on the board of supervis- ors of his county for the costs. The superintendent must discharge a 322<5 ' person found to be sane, although judged insane and confined in the hospital, and give him a certificate of sanity, a duplicate of which must be sent to the sheriff of the county. (See 3 d. habeas corpus.) 7. COST OF MAINTENANCE The expense of maintaining indigent insane in hospitals is by the state. But if an insane person has an estate more than sufficient for the support of his dependents, his guardian must pay the patient's board in advance for six months and deposit enough money to provide him with clothing. For pay patients the cost is B pa 3 y 3 " r p 6 atlents< $250 a year in advance. The person securing the admission of a pay patient must furnish a bond of $15,000 conditioned to make such payments annually for five years unless the person dies or is removed. 8. CRIMINAL INSANE When a person indicted for an offense is acquitted on the ground quitted^! crime of insanity, the jury rendering the verdict must so state, and also 1S4 ' whether the accused has since been restored to his reason, and whether he be dangerous to the community; and if the jury certify that he is still insane and dangerous, the judge must order him to be confined in one of the state hospitals for the insane. 134 MISSOURI Board of charities and corrections. Revised Statutes. 1316. Board of managers. 1367. 1386. 1387. Superintend- sr 1391 Authorities: Revised Statutes of Missouri, 1909 Laws of Missouri, 1911 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities and corrections consists of six persons, two of whom must be women and, of the remaining four, not more than two may belong to the same political party, ap- pointed by the governor, who is ex-offick^a member of the board, for terms of six years. The governor may remove members of the board for cause. The board has power to investigate the whole system of charities and correction and must examine the condition and management of all state, county and municipal charitable and penal institutions. Officers of the various institutions must furnish the board such in- formation as it demands. The board must make a full report biennally to the governor. b. Institutional. The state hospitals are under the management of boards of managers of five members each, appointed by the governor for terms of four years. The managers have the care and control of all the property of the institution and general responsibility of its management. They appoint the superintendent, assistant physi- cians, treasurer, steward, and may remove any officer except the superintendent at pleasure, and may remove the superintendent for incompetency or any misconduct. They prescribe the duties of the different officers and fix the terms thereof. The superintendents of the several state hospitals must be physi- cians of acknowledged skill in their profession and have had exper- ience in the management and treatment of the insane, and may not engage in outside practice. They employ and may discharge for cause nurses, attendants and other necessary persons. The St. Louis city sanitarium for the insane is under municipal control and management. 2. CARE a. In state institutions. State Hospital No. 1, Fulton; established 1850; 1,250 beds. State Hospital No. 2, St. Joseph; established 1874; 1,550 beds. State Hospital No. 3, Nevada; established 1887; 1,209 beds. State Hospital No. 4, Farmington; established 1903; 626 beds. b. In local institutions. The city of St. Louis provides a small institution for the care of its insane, while a few mildly insane. pa- 135 MISSOURI tients are cared for at the St. Louis city infirmary. The Marion Bounty hospital and the St. Charles county asylum receive insane patients. Insane persons who can not be cared for in the state hospitals may be received in the county almshouses which are under management of the county courts. 3. COMMITMENT a. Persons committed. Persons afflicted with any form of in- *4<>o. sanity must be admitted to the state hospitals for the insane. b. Legal procedure in commitment. When a citizen residing in Petition, the proper county files with the clerk of the county court a state- ment, in writing and in prescribed form, alleging that a person is I 4 I 9. insane and in need of hospital treatment, the clerk must issue sub- poenas for the persons named as witnesses, and such other persons as he may think proper, to appear before the county court at a specified time, which must be the first day of the first session of the court thereafter. The county clerk must convene the county court I ^ 20 - forthwith for the purpose of passing upon the sanity or insanity of the poor person apprehended. At the hearing the court must have He I ^ g - the witnesses examined before themselves, or a jury, if one be ordered for the purpose. At least one of the witnesses examined must be a reputable physician. If the court, or the jury, is satisfied of the commitment truth of the facts of the statement, it must enter an order to the effect that the person found insane is a fit subject to be sent to the state hospital, and require the medical witness to make out a de- tailed history of the case in the prescribed form. The clerk of the court must send a certified copy of the order of court to the superin- f d e ^ s e s ^ on for tendent of the hospital, accompanied by a request for the admission to the hospital of the person found to be insane. The superintend- w*- ent must immediately advise the clerk whether the patient can be received, and at what time. A pay patient, or one not sent to a hospital by order of the court, Pft y patients, may be admitted on request to the superintendent in a prescribed form made by the person by whose direction he is sent, stating his age and place of nativity, if known, place of residence, occupation and degree of relationship to the person requesting his admission. Accompanying the request must be a sworn certificate of insanity in prescribed form, dated within two months, by two physicians. Be- fore a private patient is admitted, thirty days' charges must be paid in advance and a bond with securities to insure payment of further charges must be given. Indigent patients must always be given preference over pay pa- *4U- tients. MISSOURI 136 If there are not sufficient accommodations, cases of less than one- year's standing have preference over those of longer standing; but no county may have more than its just proportion according to its insane population. c. Voluntary admission. (See 3. b. Pay patients.) Habeas corpus, d. Appeal from commitment. Any person restrained of his liberty may prosecute a writ of habeas corpus to inquire into the cause of his confinement or restraint; and any court empowered to grant the writ must do so without delay. e. Cost of commitment. The cost of examining patients and removing them to a hospital is a charge upon the treasury of the county of their residence. 4. CONVEYING PATIENTS TO THE HOSPITAL The sheriff of the county, or any other suitable person, must be directed by the clerk of the county court to convey the insane person 1435. to the hospital. The relatives of the insane person have the right, 1412. if they choose, to convey him. Before sending patients to the hospital, the county court must see to it that they are free from contagious disease, properly cared for and clothed. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Sndent? uperin " The superintendent may parole a patient whenever he deems it 1405. best for the patient. The superintendent may discharge any patient 1404- w ho, in his opinion, has been fully restored to reason. (See 3. d. Habeas corpus.) 7. COST OF MAINTENANCE The counties sending insane poor to the hospitals must pay semi- annually in cash and in advance for their support and maintenance, and, in addition, the actual cost of their clothing, and if they die, the cost of burial expenses. Moneys paid and unexpended are refunded the counties. pa!ients ay ^ ^ ne county court so orders, the clerk must transmit to the padets. county superintendent a certificate stating that any patient in the hospital x * 28 - has not estate sufficient to support him there. Whereupon, the person becomes a county patient, to be supported by his county. Jaents 0unty If tne county court so orders, the clerk must transmit to the patiets. pay superintendent a certificate stating that any patient in the hospital 1429. from his county has sufficient estate to support him at the hospital. Thereupon the patient becomes a pay patient, and the charges must be made out and paid, and a bond required and executed as in all other cases of pay patients; and upon a failure thereof, after reason- able delay, the superintendent must discharge such patient. 137 MISSOURI If any insane person admitted to a state hospital as a patient has Est |g e liable - estate, the guardian must pay for his support and expenses out of the estate. If the insane person at any time comes under the class of "insane poor persons" he must be supported and maintained by his county. 8. CRIMINAL INSANE When a person indicted for any crime after his indictment andP await- before his trial becomes insane, the court must order a jury to try 5207. and decide the question of his insanity. The alleged insane person must be notified of such proceedings, unless the court order such person to be brought before it. If the jury is satisfied that the J person has become insane, they shall so declare in their verdict, 5208. and the court must order him to be conveyed to the state hospital and there kept until restored to reason. When a person, tried upon indictment for any crime or mis- ^ u "ted S of " demeanor, is acquitted on the sole ground that he was insane at the m ^o, time of the commission of the offense, the fact must be found by the jury in their verdict, and the jury must further find whether or not he" has entirely recovered from his insanity; if recovered, he shall discharged from custody. In case the jury finds that the prisoner to ^hospital. has not entirely recovered and is not a poor person, and the court is satisfied that it would be unsafe to permit him to go at large, the court must commit him to the hospital, the costs of commitment and all expenses for the support and maintenance of such prisoner to be paid out of the proceeds of his estate. If the prisoner is poor person, the court must remand him to the custody of sheriff or other officer of the court, at the expense of the proper county, until the county court causes him to be removed to the hospital, as in the cases of insane poor persons, but without examina- tion into his insanity. 138 MONTANA Authorities : Revised Codes of Montana, 1907 Laws of Montana, 1913 i. ADMINISTRATION AND SUPERVISION fommiss f ionere. a ' General. The state board of commissioners for the insane, Jh. W 5 S 7 f 19I3> consisting of the governor, the secretary of state and the attorney . general, is charged with the care, custody, maintenance and treat- ment of the insane in safe and suitable buildings at the state hospital. Devised Codes. T ne board makes its own rules and regulations, and prescribes the duties of the superintendent of the state hospital; it must inquire into the conditions at the hospital and see that the inmates are properly cared for. The record of the board's proceedings must be open at all times to the inspection of any citizen. The board also "" has authority to send insane persons to friends outside of the state at public expense or to the institution of another state, provided they are indigent, instead of to the state hospital. The board reports biennially to the legislature. superintend- b< institutional. There is no local board of trustees. The gov- ch^V* I9I3> ernor appoints with the approval of the senate a superintendent j; ' (salary $4,000) and assistant superintendent (salary $3,000) for the state hospital for the insane ; they must be regularly licensed physi- cians of the state. Their tenure of office is four years and until their successors have been appointed; they may be removed by the state board of commissioners upon formal charges in writing. The super- intendent has immediate control of the state hospital subject to the regulations of the board of commissioners and appoints additional medical assistants subject to the approval of that board. 2. CARE a. In state institutions. Montana State Hospital for the Insane, Warm Springs; established 1877; 1,000 beds. b. In local institutions. Harmless indigent insane and persons who can not be received at the state hospital may be provided for at the poor farms, which are under the boards of county commis- sioners, or they may be cared for elsewhere under contract. 3. COMMITMENT Revised ;codes. a< Persons committed. All residents of the state, not idiots, are entitled to admission to the state hospital. Non-residents who have become insane while within the state are also admitted. 139 i MONTANA b. Legal procedure in commitment. Whenever it appears to the Examination, satisfaction of the magistrate of the county that any person within the county is so far disordered in his mind as to endanger health, person or property, he must have the person arrested and taken before any district judge in the county for examination, or, in his absence, before the chairman of the board of county commissioners. The judge or chairman of the board must issue subpoenas to two or "as- more witnesses best acquainted with the insane person and at least two graduates of medicine, to attend and testify at the examination. "3 6 - If the physicians believe the person to be dangerously insane, they c "*^f*^ of must make a certificate to this effect, describe the symptoms, etc., 3- -and give other facts, in a form prescribed by the board of commis- sioners for the insane. If the judge, or the chairman of the board of "41- county commissioners, after such examination and certificate are made, believes the person to be dangerously insane, he must order him to be confined in the state hospital, and a copy of such order commitment must be filed with and recorded by the clerk of the district court of the county. When an insane person is examined and committed by hearing ^f > o r e e edings before the chairman of the board of county commissioners, the^^||!^ latter must reduce all the evidence to writing, and the same, together Jj*** 16 * with all orders, subpoenas, complaints, warrants and papers in the "46- case, must be filed in the office of the clerk of the district court of the proper county. In all cases of hearings by the chairman of the board of county commissioners, the proceedings must be examined and certified, and approved or rejected by the judge of the district court. c. Voluntary admission. d. Appeal from commitment. Every person restrained of his Ht ^ e * s cor P us - liberty may prosecute a writ of habeas corpus and upon petition the 9633. circuit or district court must grant it. e. Cost of commitment. The costs of the examination, committal f a ^ t y y the and taking of an insane person to the hospital must be paid by the 4S- county in which he resides at the time he is adjudged insane. The sheriff is allowed the actual expense incurred in taking an insane person to the hospital. 4. CONVEYING PATIENTS TO THE HOSPITAL The insane person, together with the order of the judge or chair- jjjj*^ the man of the board of county commissioners, and the certificate of the "* 3 ' physicians must be delivered to the sheriff of the county and by him to the officer in charge of the state hospital. MONTANA 140 Discharge. 1124. Clothing and money. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Upon the written report of any person appointed by the board of commissioners of the insane to examine into the condition of a patient, that he is in fit condition to be at large,, the board must cause him to be discharged from the hospital. Every insane person on recovery, must be discharged from the hospital or place of confinement. Indigent patients when discharged must be provided with $20 in money and comfortable clothing. (See 3. d. Appeal from commitment; habeas corpus.) Nonindigcnts. "33- Indigents. 7. COST OF MAINTENANCE The care and maintenance of non-indigent insane must be paid or guaranteed by their parents, children or guardians. When a person is adjudged to be insane and ordered confined in the state hospital, the judge or person before whom the hearing is must take evidence as to the financial worth of the insane person. If he has any means out of which the expenses of his maintenance in the state hospital, or any part thereof, can be paid, the judge or person before whom the hearing is had must cite the persons in possession of his property, and his relatives, if there are any in the county of his residence, to appear and show cause why a guardian should not be appointed for him and ordered to pay the costs of his maintenance, or as much of it as his means will permit. If the insane person has property that can be applied towards his maintenance, the court must make an order to that effect, stating how much of it shall be applied. Indigent insane are maintained at the hospital at the cost of the state. Jury trial. Commitment to state hospital. Expense of commitment. 9526. 8. CRIMINAL INSANE If a doubt arises as to the sanity of the defendant in a criminal action, the court must order the question as to his sanity submitted to a jury. If the jury finds the defendant insane, the trial or judg- ment must be suspended until he becomes sane, and the court must order that he in the meantime be committed by the sheriff to the state hospital for the insane, and that upon his becoming sane, he be re-delivered to the sheriff. The expenses of sending the defendant to the hospital, keeping him there, and of bringing him back, are chargeable upon the county in which the indictment was found, or the information filed; but the county may recover from the estate of the defendant, or from a rela- 141 MONTANA tive of the town, city or county bound to provide for and maintain him elsewhere. Insane convicts must be received into the hospital on the order ^^ c e ts of the board of state prison commissioners, and returned to the " 3I - state prison upon recovery if sentence has not expired. 142 Board of charities and corrections. Revised Statutes. 5826. Commissioners of state institu- tions. 7179. 7183. 7106, 7i8 S . Superintend- ent. 7189. NEBRASKA Authorities: Revised Statutes of Nebraska, 1913 Laws of 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities and corrections is composed of the governor, the superintendent of public instruction and the commissioner of public lands and buildings. The board has the duty to inquire into the whole system of public charities in the state and counties and to ascertain the condition of all institutions. The governor may at any time in his discretion order a special in- vestigation to be made by the state board or by a committee of its members, or advisory secretaries, into the management of a state hospital or county institution in the state. A report of such in- vestigation must be submitted by the governor to the legislature. The board must make a full report of its proceedings biennially to the governor. The board of commissioners of state institutions consists of three members appointed and removed by the governor with the consent of the senate. The members receive $3,000 per annum and necessary expenses, and hold office six years; no two maybe appointed from the same congressional district and no more than two may belong to the same political party. Each institution must be inspected thoroughly by the whole board every six months and by some member every thirty days. The board has general control and management of all state chari- table, penal, and correctional institutions, including the hospitals for the insane, with authority to make all necessary rules for their government, including regulations with regard to the classes of patients to be admitted to each, their transfer, etc. The board appoints a superintendent, assistants and steward for each state hospital and a matron for the Nebraska State Hospital. All appointments remain effective until revoked by the board. b. Institutional. There are no local boards of trustees. 2. CARE a. In state institutions. Nebraska Hospital for the Insane, Lincoln; established 1870; 700 beds. Norfolk State Hospital, Norfolk; established 1887; 450 beds. Nebraska State Hospital, Ingleside; established 1889; 1,300 beds. b. In local institutions. In case a person found insane can not be at once admitted to the hospital for lack of room or other cause, 143 NEBRASKA the county commissioners of insanity direct the commissioners of the county or overseers of the poor to care for him in the poorhouse, or Poorhouses. if there be none and no more suitable place can be found, in the jail. Jails - Lists of such deferred cases are kept and reported to the state board. 3. COMMITMENT a. Persons committed. Insane persons, except idiots, whether they have a legal residence in the state or not, are admitted to the hospitals. Dipsomaniacs, inebriates and persons addicted to drugs are admitted to and treated in the Nebraska Hospital for the Insane at Lincoln. b. Legal procedure in commitment. In each organized coun the state there must be three commissioners in insanity, and the clerk of the district court is one of them, ex-officio. The other mem- bers are- appointed for terms of two years by the judge of the district court, and one must be a respectable practicing physician and the other a respectable practicing lawyer. In the temporary absence or inability to act of two of the commissioners, the judge of the district court, if present, may act in the place of one of such commissioners, or the commissioner present may call to his aid a respectable practic- ing physician or lawyer. The clerk of the board must issue all 7345. notices of the appointments, warrants, subpoenas, etc. He must keep separate books of the proceedings of the board, to constitute, 7246. with the papers filed, a complete record of their findings, orders and transactions. The commissioners have cognizance of all applica- tions for admission to the hospital or for the safe-keeping of insane persons within their respective counties, except in cases otherwise provided for. They have power to issue subpoenas, administer oaths, and do any act of court necessary in the premises. Application for admission to a hospital must be made to the Application, county commission of insanity in writing, verified by affidavit, alleg- ing that the person applied for is believed to be insane and a fit subject for custody and treatment in a hospital, that he is found in the county and has a legal settlement therein, or, if not, where it is believed to be. The commissioners must at once take steps to investigate the grounds of the information. They may require the investigation, alleged insane person to be brought before them, and the examina- tion had in his presence, providing for his custody until their Examination, investigation is concluded. They may dispense with his presence if it would probably be injurious to him or attended with no advantages. They must hear testimony for and against the ap- plication. Any citizen of the county or any relative of the person may resist the application, and employ counsel if they choose. The commis- NEBRASKA 144 Warrant. 7250. Provisions for patients who can not be admitted. 72S7. Private patients. Public patients. Care of insane persons out of hospitals. 7258. Insane persons without proper care. 7259- Transfer of insane under care of commissioners to hospitals. 7262. Order of admittance of patients. 7263. sioners must in all cases appoint some regular practicing physician of the county to make a personal examination of the person alleged to be insane. The physician may or may not be of their own num- ber, and the one appointed must certify whether he finds the person in question insane or not. He must endeavor to obtain from the relatives of the person in question, or from others who know the facts, correct answers so far as may be to the interrogatories pre- scribed by law, which with the answers to them must be attached to his certificate. The commissioners thereupon must find whether the person is insane, and whether if insane, a fit subject for treat- ment and custody in the hospital and where his legal settlement is. If they find him insane and a fit subject for custody and treatment in the hospital, they must issue their warrant authorizing the superin- tendent of the hospital to receive him as a patient. If a patient can not at once be admitted for want of room or for any other cause, and can not with safety be allowed to go at liberty, the commissioners must provide suitably for him, until admission can be had or the occasion for it no longer exists. Such patients may be cared for either as public or as private patients, those being treated as private patients whose relations or friends will obligate themselves to provide for them without public charge, in which case the commissioners must appoint some suitable person as special custodian, with authority to restrain, protect and care for such pa- tient. In the case of public patients, the commissioners must require that they be properly cared for by the commissioners of the county or overseers of the poor at the expense of the county. If there is no poorhouse, or no more suitable place, they may be con- fined in the jail of the county in charge of the sheriff. On application to the commissioners on behalf of persons al- leged to be insane and whose admission to the hospital is not sought, the commissioners may provide for them as in the case of other ap- plicants. If the commissioners of any county are informed that any insane person is suffering for want of proper care, they must make all needful provisions for him as provided in other cases. Insane persons who have been under care, either as private or public patients, outside of a hospital, by authority of the commis- sioners of any county may on application be transferred to a hos- pital on the warrant of the commissioners. The admission may be had without another inquest, at any time within six months after the inquest already had. If it becomes necessary for want of room or other cause to dis- criminate in the reception of patients, a selection must be made as follows: 1, recent cases (cases of less than one year's duration); 145 NEBRASKA 2, chronic cases (of more than one year's duration) presenting the most favorable prospects of recovery, 3, those for whom application has been longest on file, other things being equal; and 4, when cases are equally meritorious in all other respects, the indigent insane have preference. c. Voluntary admission. d. Appeal from commitment. On a sworn statement to a judge of the district court of the county in which a hospital is situated, or of the county in which any certain person confined in a hospital insane, has his legal settlement, alleging that such person is not insane, the judge must appoint a commission of inquiry of not more than three persons, one of whom mus^t be a physician, and if two or more are appointed, one must be a lawyer. Their report must be accompanied with a statement of the case by the superintendent. If the judge finds the person not insane, he must order his discharge; if not, he must authorize his continued detention. The commissioners are entitled to their necessary expenses and a reasonable compensation, to be paid by the applicant if the application was made without probable grounds. A commission may not be repeated oftener than once in 7265. six months in regard to the same person, nor may such a commission be appointed in the case of any patient within six months of the time of his admission. All persons confined as insane are entitled to the writ of habeas Hab * s cor P us - 7 2 o6. i corpus, and the question must be decided at a hearing; an adverse decision does not bar the issuing of the writ a second time or when- ever it is alleged that the person has been restored to reason. If at such a hearing it appears that the patient was irregularly, committed but is not restored to reason, he may be returned to the county from which he was committed to be proceeded with according to law. e. Cost of commitment. The expenses connected with the com- Pa; d by county r or state. mitment and transportation of a patient to the hospital are to be 7253- paid by the county in which he has a legal settlement. If he has no 7254- settlement they are borne by the state. 4. CONVEYING PATIENTS TO THE HOSPITAL The sheriff must convey the insane person to the hospital; or, in 7350. his absence, the commissioners of insanity may appoint some other suitable person. No female may be taken to the hospital without the attendance of some other female or some relative of such person, f^^ant The superintendent in his acknowledgment of delivery must state whether there was any such person in attendance. If any relative or immediate friend of the patient who is suitable request it, he has NEBRASKA 146 Discharge by the superin- tendent. 7268. By board. 7269. Liability for support. 7272. Pay patients. Laws of 1917, ch. 132. Medical board. Revised the privilege of executing the warrant in preference to the sheriff or any other person. 5. TRANSFER OF PATIENTS This is within the exclusive jurisdiction of the board of com- missioners of state institutions. 6. PAROLE AND DISCHARGE OF PATIENTS Any patient who is cured must immediately be discharged by the superintendent and furnished with suitable clothing and a necessary sum of money. The relatives of any patient not susceptible of cure and harmless have the right to remove him on the consent of the board of commissioners. On the application of the relations or immediate friends of any patient, except one under charge or conviction of homicide, who is not cured, and who can not safely be allowed at liberty, the com- missioners of insanity of the county where he belongs, on making provisions for his care within the county, may authorize his dis- charge. Incurable and harmless patients must be discharged or removed whenever it is necessary to make room for recent cases. When it is shown to the satisfaction of the commissioners of in- sanity of any county that cause no longer exists for the care within the county of any particular person as an insane patient, they must order his immediate discharge. 7. COST OF MAINTENANCE The cost of board, care and treatment of patients while in the hospitals of the state is borne by the state, unless some legally liable relative has sufficient means to do so. The commissioners of the several counties are authorized, however, to collect from the property of such patients, or from any person or persons legally bound for their support, any sum paid by the county in their behalf. The relatives or friends of any patient in a hospital for the insane have the privilege of paying any portion or all of his expenses. If the husband or parent is possessed of an estate or income suf- ficient to meet the expense, they are required to pay an amount equal to the cost of maintenance. 8. CRIMINAL INSANE If a person charged with crime becomes insane after the offense, a jury must be impaneled to determine the question of insanity. The physician of the state penitentiary, the superintendent of one of the hospitals for the insane and a secretary of the state board of health constitute the penitentiary medical board. When the physi- 147 NEBRASKA cian of the penitentiary believes that a convict is insane, he must so J^ c e ts certify to the governor, who shall immediately cause an examina- 72 - tion to be made by the penitentiary medical board, and upon its certificate, the governor may direct the convict to be removed to one of the hospitals for the insane. When the superintendent is satisfied %*$** on to that a convict in his custody is restored to sanity, he must so certify w 1 - to the governor of the state, who must order the convict to be re- turned to the penitentiary to serve the unexpired term of his sentence, less the time of his confinement in the hospital. 148 Board of Commissioners. Laws of 1913, ch. 231. NEVADA Authorities : Compiled Laws of Nevada, 1912 Laws of 1913, 1915 I. ADMINISTRATION AND SUPERVISION a. General. The board of commissioners for care of indigent Superintend- 6.' Application. Laws of 1915, Ch. 71. Examination. insane, consisting of the governor, state treasurer, and state comp- troller, has full power and exclusive control of the state hospital for the insane and its inmates, of the appointment and removal of a superintendent, and of establishing the regulations and by-laws for its government. A record of their proceedings must at all times be open to inspection by a committee of the legislature, and they are required to make a biennial report in detail to the legislature of all that pertains to the activities of the hospital. b. Institutional. There is no local board of trustees. The super- intendent must be a graduate in medicine; his salary is $2,400 a year; and he is empowered to employ all necessarj help needed at the hospital, subject to the approval of the board of commissioners, to which he is required to make a monthly report of the operations of the institution. 2. CARE a. In state institutions. Nevada Hospital for Mental Diseases, Reno; established 1882; 300 beds. b. In local institutions. There is no provision for the local care of insane in almshouses or other local institutions. 3. COMMITMENT a. Persons committed. All insane residents of the state are entitled to admission to the state hospital. Idiots and feeble- minded persons may be admitted if it is found to be for the best interests of the county of which they are residents. b. Legal procedure in commitment. The judge of the district court in each judicial district in the state, or in his absence the county 19I3> c l ei> k, upon the sworn application that any person by reason of in- sanity is unsafe to be at large because of his homicidal, suicidal, or incendiary disposition, which must not be the result of delirium tremens, harmless imbecility, or feeblemindedness, either congenital or as the result of alcohol, drugs, or the natural failing of old age, must cause such person to be brought before him, and cite one or m ore licensed practicing physicians to examine the person alleged to be insane. If the physicians certify upon oath that the 149 NEVADA charge is correct, and if the judge is satisfied that the person is by reason of insanity, unsafe to be at large, incompetent to provide for his proper care and support, has no property applicable for such purpose, and has no husband or wife, father or mother, children, brother or sister living within the state of sufficient ability to pro- vide care and support, he must commit him to the hospital, and commitment transmit to the superintendent a copy of the complaint, commit- ment, and physicians' certificate, together with a transcript of the court examination, which must be in the form prescribed by the board of commissioners. c. Voluntary admission. , d. Appeal from commitment. Any person restrained of his ^om e 1fed^aws! liberty may prosecute a writ of habeas corpus to inquire into the 6 " 6 - cause of it. A writ may be granted by any judge of the supreme or 6 " 8 - district courts. e. Cost of commitment. The district judge must inquire mto J w 2 s 3 f . 1913 ' the ability of insane persons committed by him to bear the expenses 9 - attending commitment to the hospital. If the insane person has means, the district judge must appoint a guardian, who shall pay all proper costs and charges incidental to commitment. If the per- son is unable to pay the costs of commitment, the judge may them among such of the patient's kindred residing in the state as he may deem just and equitable; otherwise, the expense of committing indigent insane persons from the various counties of the state to the hospital constitutes a charge upon the state. 4. CONVEYING PATIENTS TO THE HOSPITAL The person committed must be delivered, together with the * warrants of the judge, certificates of the physician, and a transcript l8 - of the court proceedings, to the sheriff of the county. The sheriff notifies the superintendent of the state hospital, who designates a hospital employee to transport the insane person to the hospital, which employee the sheriff must deliver the patient. Any relative of the first degree has the right, however, to act as attendant at his own expense, and no female may be conveyed to the hospital without at least one female attendant or a relative the first degree. The expense of sending patients to the hospital must be paid by , 1 ^ e of ance the guardian if the patient has means ; if the patient is indigent, the cost may be assessed among near relatives residing in the state; otherwise, the cost of conveyance is paid by the state. NEVADA 150 x 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS All patients committed to the state hospital are considered to be on probation for the first thirty days. At the end of the probation- ary period the superintendent may, if he deems it desirable, notify the board of commissioners, asking it to authorize him to request the district judge of the county in which the hospital is located to Examination, appoint SL commission of three competent physicians to examine the patient. If the commission determines that the patient is not un- safe to. be at large by reason of his insanity, although unsafe at large because of feeblemindedness, illness, or bodily infirmities, the super- Discharge, intendent must notify the commissioners of the county from which the patient was committed, and the commissioners must take the patient back to the county at the county's expense. Should the Retention. commissioners agree to pay the state the actual expense of maintain- ing the patient at the state hospital, the patient may be kept at the state hospital at the expense of the county. 7. COST OF MAINTENANCE compn y ediaws.' Indigent insane persons are cared for at the hospital at the expense of the state. In the case of a patient of means, a guardian is ap- P * r 2oo Shable ' P om ^ed who must pay for his care and support during the period of his insanity, or so long as there is sufficient means to meet the 2j expenses. If such insane person has no means applicable to his ^ support, but has kindred in the degree of husband or wife, or (if a minor) father or mother living within the state, of sufficient means, ^ the judge before whom the examination is had must order all ex- penses and charges paid by the nearest of such kindred, or may Q assess them among the kindred as he may deem equitable. J 8. CRIMINAL INSANE Ij When a defendant in a criminal case appears to be insane, the question must be submitted to the regular or to a special jury. An >. acquittal on the ground of insanity must be followed by an order of JJ the court committing the person to the hospital for mental diseases. v?Ch W 23i f . 1913 ' When a convict undergoing imprisonment in the Nevada state (t 15- prison becomes insane and is so adjudged by a commission of lunacy appointed by the court as in other cases of insanity, the warden must deliver him to the superintendent of the state hospital for detention and treatment. If the convict is restored to sanity before the expiration of his sentence, he must be returned to the warden of the state prison to serve the unexpired term of his sentence, unless he is released by order of the board of pardons. 151 NEW HAMPSHIRE Authorities : Public Statutes of New Hampshire, 1901 Supplement to Public Statutes of New Hampshire, 1901-1913 Laws of New Hampshire, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of health, which is composed of 1 < ^ c mission the governor, the attorney general, three physicians and a civil P.s.ch.io. engineer, constitute a commission of lunacy. The physicians and engineer are appointed by the governor for terms of four years. The commission is charged with the duty of visiting and inspect- 34. ing all hospitals and other institutions for insane persons at least once in four months, and to examine into all matters relating to the care and general welfare of the inmates. It may order the removal 35. of any indigent insane person to the state hospital. The commission must keep a correct record of the number of commitments, discharges and deaths at each hospital, institution or other place of detention, giving details as to age, sex and nation- ality, and report the same annually to the governor and the council. The superintendent of every hospital or other place where insane are confined must within three days after the commitment of any person notify the commission of lunacy of the fact. Any person or corporation desiring to maintain a sanatarium Jt s or hospital for the reception of persons of unsound mind or for the Laws of 1917. treatment of specific diseases must first make application to the state * board of health. After investigation the board may issue a license to the applicant with such restrictions as are deemed necessary. The hospital or sanitarium must be open to inspection by the board 3. of health at all times. Any person violating the above provisions may be fined not more than $500 or imprisoned for not more than one year, or both. The board of charities and corrections is composed of five persons Board of cha appointed by the governor and the council for five years. T members receive no compensation except expenses incurred. The secretary of the state board of health is ex-officio a member of the board of charities. The board has the duty of inspecting all state and county charitable and correctional institutions. The board must report biennially to the governor and may make recommenda- tions to the county commissioners. The board of trustees of state institutions consists of the governor J and five persons who are appointed by him with the consent of the^ s s - o{ council for terms of five years. The members receive eight dollars ch - 2 6 - NEW HAMPSHIRE 152- a day and expenses for each day they are engaged in their official ch. 112. duties. The board has control of five institutions including the hospital for the insane. All the powers and duties heretofore im- posed and conferred upon the boards of trustees of each of these institutions are now imposed upon the new board of trustees. The board must hold a regular meeting at least once each week, and at such other times as its duties require, for the purpose of hearing such matters as the superintendents of the institutions may desire 4- to bring to its attention. Each institution must be visited and inspected by a member of the board at least once each month and the board must make rules for such visits by. its members in rotation went asiag an( * suc h otner ru l es as ma y be deemed proper. The board must Jh.T 7 e f I9IS ' em Ply a competent person to act as purchasing agent for all state 6,7,9- departments and institutions; his annual salary must not exceed $3000. b. Institutional. There is no local board of trustees of the state hospital for the insane. The superintendent is appointed by the board of trustees of state institutions. 2. CARE a. In state institutions. New Hampshire State Hospital, Concord; established 1843; 1,250 beds. b. In local institutions. There are no local public institutions for the insane. 3. COMMITMENT p.s g .ch. 2 . a< Persons committed. All insane persons, residents of the state are entitled to admission to the state hospital. The term insane in- cludes every idiot, non compos, lunatic, insane or distracted person. ch^io. ft. Legal procedure in commitment. The parent, guardian or friends of any insane person may cause him to be committed to the j s- state hospital with the consent of the trustees. Any insane pauper supported by a town may be committed to the hospital by order of l6 - the overseers of the poor and supported at the expense of the town. In case the overseers neglect to make such order in regard to any insane county pauper, the supreme court or any judge thereof may order him to be committed to the hospital and supported at the '? expense of the county. If an insane person is in such condition as to be considered dangerous while at large, a judge of probate upon petition by any person and notice to the selectmen of the town, ch W o f 1{ ^ 7 ' ma y commit him to the hospital. No person may be committed to the state hospital, except by an order of the court or the judge of probate, without the certificate of two reliable physicians, given after a personal examination made within one week of the committal. 153 NEW HAMPSHIRE When application is made to' the judge of probate or of the supreme ^p^tment of court for the committal of any person to the state hospital, the court physicians. may appoint two reputable physicians to examine said person, with or without notice to him from the court. The physicians must p -& <=h. 10. immediately report the result to the court, who may upon their re- SU PP- P- s. port order the person to be committed to the state hospital when there is a sufficient reason for so doing. The certificate of the phy- sicians must be accompanied by a certificate of the judge of the supreme court or court of probate, mayor or one of the selectmen. c. Voluntary admission. The superintendent of the hospital may ^ u a p y er ^ t dent receive and detain any person who applies to submit himself for ^aws of 1917, treatment. Notice of admission must be given to the board of lunacy. The patient may not be detained more then seven days after notice of intention to leave is given. The charges for support are governed by the law relating to insane persons. d. Appeal from commitment. The supreme court, or any justice Application. thereof, at any time, with or without notice, when proper application P - 7 S - ch - I0 * is made, must investigate the question whether there is sufficient reason for the detention of any person who has been committed to the hospital, and must order his discharge if it ought to be made. e. Cost of commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS The state board of commissioners of lunacy is empowered to SU PP- P- l6 - transfer any indigent insane person to the state hospital, to be sup- ported by the state, provided satisfactory affidavits are executed by the cojunty selectmen or the board of commissioners or both, and the board may declare that in its judgment the patient or any patient chargeable is able to bear the expense incident to his maintenance at the hospital. 6. PAROLE AND DISCHARGE OF PATIENTS The superior court or any justice thereof may parole a person Parole by court. committed to the state hospital upon such terms and conditions as justice may require; and the court or justice may at any time revoke the parole and order the person returned under the original com- mitment. The superintendent with the approval of the board of trustees ^p"jj n k ndent of state institutions may grant parole' for a period not exceeding six ws of 1915, months. Any person committed to the state hospital may be discharged by p is s h c^ g f any three trustees, by the commission of lunacy, or by a justice of Su a p ^ p ig> the supreme court, whenever further detention at the hospital, in NEW HAMPSHIRE 154 their opinion, seems unnecessary; but a person so discharged, who was under sentence of imprisonment at the time he was committed, must be remanded to prison for the unexpired period of his sentence of imprisonment. Provision is made for inmates of the hospital to make statements in private to a trustee, and whenever a trustee deems it proper he must call to his aid two other trustees who after further examination of the inmate and statements made by him are in duty bound to discharge him if, in their judgment, further deten- tion is unnecessary. 7. COST OF MAINTENANCE An insane person committed to the hospital, who has no means of support, no relatives of sufficient ability who are chargeable with his support, and no settlement in any town in the state, and whose condi- tion is such that his discharge from the hospital would be unsafe, must be supported by the county from which he was committed. An insane person chargeable with an offense under penalty of death or confinement in the state prison, and who is committed to the hospital by order of the supreme court, must be supported at the expense of the state during his confinement. Any other insane person committed to the hospital by the supreme court, judge, or sheriff, and any insane person committed by a judge of probate must be supported by the county from which he was committed. The county or town paying the expenses for the support of an, inmate is entitled to recover the amount paid of the inmate himself if of sufficient ability to pay; otherwise of the town, county or person by law liable for his support. An insane person who has been an inmate of the state hospital for twenty years, and been supported in whole or in part during that time by others from the town or county chargeable therewith, and who has no means of support, and no relatives chargeable for it, and who can not properly be discharged from the hospital, must be supported there at the expense of the state. Indigent insane persons at the state hospital for treatment may be maintained by the state upon orders issued to that effect by the state board of commissioners of lunacy. When a patient, or rela- tives chargeable with his support, is able to pay only a part of the expenses for maintaining the patient at the state hospital, the state board upon satisfactory evidence of the facts, may direct that the part of the expense of maintenance which can not be met by the patient or relatives, shall be paid by the state. 8. CRIMINAL INSANE When a person is indicted for any offense or committed to jail on any criminal charge to await the action of the grand jury, any 155 NEW HAMPSHIRE justice of the court before whom he is tried may, on the plea of insanity, put such person into the care and custody of the superin- tendent of the state hospital, to be detained and observed by him until further order of the court. The person so committed must be supported there at his own expense if of sufficient means, otherwise at the expense of the state. Whenever the grand jury omits to find indictment against a person f u e s r ^ n f s ro e ^~ because of insanity or a person prosecuted for an offense is acquitted p 1 6 ^ 2 by the petit jury, the jury must certify the fact to the court; when J - any person prosecuted for an offense pleads that he is not guilty by reason of insanity, the court may commit him to a prison or to the 2 - state hospital to remain until discharged by due course of law if, in 3- the opinion of the court, it would be dangerous to allow him at large. The governor and council, the supreme court, may discharge any Jf* c ^ r e or such person from prison, or may transfer any prisoner who is in- j ws 6 of I9I7> sane to the state hospital to be kept there at the expense of the state, whenever they are satisfied that such discharge or transfer is neces- sary. Any prisoner may be temporarily transferred to the state hospital, for the purpose of observation, by the board of trustees of state institutions. 156 Commissioner of chanties and corrections. C. S. P. 453- Laws of 1916. 167, 3. Private hospitals. P. 3202. 108. 107. Board of managers. Laws of 1917, ch. 7. ch. 76. c.s! P- 3179. Medical director. NEW JERSEY Authorities: Compiled Statutes of New Jersey, 1910 Laws of New Jersey, 1911, 1912, 1916, 1917 i. ADMINISTRATION AND SUPERVISION a. General. A salaried commissioner of charities and correc- tions, appointed by the governor for a term of three years, has the duty of inspecting all charitable and correctional institutions re- ceiving funds from the state. He has power to see all state wards, must see all such who are in private institutions, and may require reports from the institutions under his inspection, together with other information in the form he may prescribe. The commissioner must report annually to the governor. The commissioner or some officer representing the department of charities and corrections must visit the hospitals twice a year or oftener and inquire into their facilities, equipment, sanitary condi- tions, accommodations and manner of management. All private institutions for the care of the insane must be licensed by the commissioner of charities and corrections upon plans ap- proved by him after careful inquiry. All licensed private institu- tions for the insane must be inspected at least twice a year by the department of charities and corrections . and reported upon to the governor. A private institution for the insane must have at least one properly qualified resident physician. b. Institutional. Each state hospital for the insane is under the general control of a board of managers consisting of ten persons, two of whom must be women. Not more than four of the male members may belong to the same political party. They are ap- pointed by the governor for terms of five years. Each board is authorized and directed to establish the necessary by-laws in regard to the appointment of executive officers, assistants, attendants and employees necessary for the management of the ' hospital and fixes the conditions of admission, support and dis- charge of patients. Each board appoints a medical director and as many assistants as may be deemed necessary, also a warden of the hospital, as general manager of the buildings, grounds, farms, etc., belonging to the hospital, whose duty it is, among other things, to make estimates of the amounts of money required for the support and maintenance of the hospital for the next ensuing fiscal year and to submit such estimates to the board of managers. At least one manager must visit the hospital once in every week; two or more managers at least once in each month; a majority of the board at 157 NEW JERSEY least once in three months ; and the whole board at least once a year. The board must make an annual report to the governor detailing the 3I91 - past year's operations and the actual state of the hospital. Each 66 - board is authorized to appoint a secretary. The county hospitals are under the control of the boards of chosen ^ te _ freeholders, who are authorized to appoint superintendents and other 3193. officers necessary, subject to removal by a vote of two-thirds of the - members, to fix the compensation of officers, to establish rules for the management of the hospitals, and terms of admission, support and discharge of patients. 2. CARE a. In state institutions. New Jersey State Hospital at Trenton, Trenton; established 1847; 1,600 beds. The New Jersey State Hospital at Morris Plains, Greystone Park; established 1874; 1,750 beds. b. In local institutions. There are nine county institutions, most of them designed as hospitals, which receive committed insane patients and derive support from the state at the rate of $2 a week, a patient. The Newark city hospital has a psychopathic ward. 3. COMMITMENT a. Persons committed. The indigent insane without a legal settlement in any county are committed to the state hospitals. Indigent insane having a legal settlement in some county are com- mitted to county institutions of the county of which they are legal residents or may be maintained by their counties at state hospitals. Idiots, imbeciles, and feebleminded are not considered insane unless ch. W 9 4 . f Ipl6 ' charged with commission of crime. 33> Pay patients may be received at the state hospitals when there are ; |j vacancies. 31. 79. b. Legal procedure in commitment. No one may be committed a mi hs e p n itais to or confined in any institution for the care and treatment of the p[ ta is. unty h s " insane in the state except upon filing with the medical director of the f,^ 6 ' institution an application in writing by the person interested in his admission. The application must be made on an approved form. If the patient should be placed under immediate restraint a state- wmiEiSt. ment of his condition must appear in the certificate of the physician, ch.^. * Ipl6 ' The person making the application must obtain an order of tempo- 9> I0 ' rary commitment from a judge of any court of record in the county in which the person resides. Justices of the peace are not consid- ered judges of courts of record in places where a district court exists. If it is impossible to obtain an order of temporary commitment a statement to that effect in the application and certificates will war- rant the patient's detention. NEW JERSEY 158 ofiunacy ioner La ch S 9,J, 1916 ' ch. 94. Orders of temporary commitment must contain proof of the patient's mental condition, and must be filed with the medical di- rector of the institution to which commitment is made. The orders are valid for twenty days. The medical director must mail certified copies of the temporary commitment papers to the commissioner in lunacy of the county from which commitment is requested. The commissioner must apply to the court to fix a day for the final hearing, which must not be more than 20 days from the date of the f Ipl7 'temporary order of commitment. The judge must serve notice upon the patient and others interested; may make inquiry and take proofs of insanity of the person so confined and in his discretion call a jury. The inquiry must be concluded within three months after the presentation of the application. ^ coun ties where the county counsel, county solicitor, county county physician, or county probation officer or any of their assistants is now in charge and supervision of the preparation of papers relating to the commitment of insane, such person shall be known as the commissioner in lunacy; in all other counties the judge of the court of common pleas, with the consent of the board of chosen freeholders, shall designate some county official as com- missioner in lunacy. The commissioner shall have charge and supervision of the preparation of papers relating to the commitment of the insane. The board of chosen freeholders must notify the various institutions of the name and address of such commissioner. ^ *ke justice or judge finds the person insane, he must so certify, and order him confined in one of the institutions for the care and treatment of the insane in the state until he has recovered, or is removed or discharged. The order is filed with the clerk of the county, who must forward a certified copy to the medical director of the institution in which the person is confined . If the j ustice or j udge determines that the person is sane, he must order his discharge from the institution in which he is confined, and file the papers in the case as provided above. A physician certifying to the insanity of any person for the purpose of securing his commitment as insane must be of reputable character, licensed to practice medicine, a permanent resident of the state, who has been in the actual practice of his profession for at least five years. No certificate of insanity may be made except after a personal ex- amination of the person alleged to be insane held not more than ten days prior to his confinement, and according to forms approved by the commissioner of charities and corrections. The medical certificates must contain a thorough description and identification of the person sought to be confined, and all required information on the approved forms. A non-resident of the state 159 NEW JERSEY may, however, be confined on the certificates\ of two physicians having the qualifications required by the laws of the state from which the non-resident is sent, who are residents of the state from which the non-resident is sent; but a non-resident may not be held in confinement for more than fifteen days, except upon the certificates of two physicians resident in the state of New Jersey. No physician may certify to the insanity of any person for the w- purpose of securing his confinement in any institution with which he is connected or interested in, or who is a near relative, by blood or marriage, or guardian or trustee of the person sought to be confined. Application may be made by a person interested by reason of Ls Ca of 0n i" 9 ,6 relationship or marriage, by the person having charge or care of the ^94. patient, or by a sheriff, overseer of the poor, chief of police or police captain, warden or other officer of any correctional or charitable institution in which the patient may be. Every medical director of an institution for the insane must, n g y - within three days after the reception of a patient, have a descriptive p - I 3 1 - entry recorded of his case, and from time to time other entries in regard to the mental state, bodily condition and medical treatment of the patient, together with the forms of restraint employed. In the event of the discharge or death of the patient the medical director must record the circumstances. In case of temporary commitment, the director sends copies of the papers to the county commissioner in lunacy, who presents them to the judicial officer of the county. If a person residing in the state is insane and indigent, it must to igent be set forth in the application. The justice or judge to whom appli- 132. cation is made must determine the question of his indigence as well as of his insanity. If he finds that the person is insane, but not indigent, he must so X M certify, and order him confined in one of the institutions for the care and treatment of the insane, if proper arrangements have been made for his maintenance; and the judge must ascertain, if possible, the legal settlement of the person. If the judge finds the person to be insane and indigent and to I34 - have a legal settlement in the county in which he resides, he must order him confined in the institution for the care and treatment of the insane owned by the county in which he has a legal settlement, otherwise in a state institution for the insane. If the chief medical officer of any hospital for the insane has a 3205. doubt of the insanity of a patient admitted by him, he must certify it to the county commissioner in lunacy. The proceedings in committing insane patients to private in- stitutions are the same as those required for commitment to public institutions. NEW JERSEY 160 Application. c> Voluntary admission. Any resident of the state, believing *43. himself about to become insane and desiring to submit himself to treatment, may be admitted to any state hospital for the insane upon application to the medical director. The application must give all the facts in the case, including a declaration as to the financial condition of the applicant. The county commissioner in lunacy is notified and determines the patient's financial condition. He is sup- ported on the same terms as one committed. J 44- A voluntary patient may be discharged upon the certificate of the medical director, because he is cured or because treatment in the institution is unnecessary or undesirable. A voluntary patient may leave the institution upon three days' notice to the medical director. '35. d. Appeal from commitment. The patient or any friend or relative in his behalf may obtain a writ of habeas coVpus. ch%4 f Ipl6 ' e. Cost of commitment is borne by the applicant or the county. 4. CONVEYING PATIENTS TO THE HOSPITAL Laws of .1916, When a female patient is to be taken to any institution she shall 35- be accompanied by husband, brother, father, son or family physician or suitable female attendant. 5. TRANSFER OF PATIENTS Laws of 1916, The judicial officer of the county has authority to order a transfer, 30 - the cost of which is borne by the institution from which the patient is transferred. 6. PAROLE AND DISCHARGE OF PATIENTS il^s e 0^1916 ^ nv P at i ent except one transferred from a penal or correctional ch. 167. institution may be paroled or discharged on the certificate of the medical director under regulations prescribed by the board of managers of the state hospital or freeholders of the county. Pa- tients discharged must be furnished with suitable clothing and necessary traveling expenses, not exceeding $10. The board of managers may discharge an indigent non-resident S g patient to relatives living in another state or foreign country when it can be done without danger to him; or any non-indigent patient if those liable for his board are six months in arrears of payment. (See 3. d. Appeal from commitment; habeas corpus.) 7. COST OF MAINTENANCE The state P a y g $2 - 50 P er week toward the cost of the support of indigent patients in the state hospital; and the county from which they were sent pays $2 per week and furnishes clothing. Indigent patients without a legal settlement in any county are supported by the state. 161 NEW JERSEY Every insane person in an institution for the insane is personally Partie s liable, liable for his maintenance. The trustee, guardian or relative bound *&' by law to provide for him if he had not been sent to the institution is liable for the expenses of his clothing and maintenance. The parents, grandparents, the children and grandchildren, husband or X 3. wife, if of sufficient ability, of every insane person in an institution for the insane whose estate is not sufficient for his support, are liable for his maintenance. If, after commitment as indigent, a person is able to pay for his w- maintenance, or some other person is able to pay for it, or some other person is legally bound for his support, the county from which he was committed must collect the sums due for his maintenance. When it is found after the commitment of any person as a non-indigent pa- tient that his estate is unable to pay for his maintenance, he becomes on judicial order an indigent patient, and his board and maintenance are a charge upon the county in which he has a legal settlement. 8. CRIMINAL INSANE When a person has escaped indictment, or been acquitted of a Pers n / ex - * r cused from criminal charge upon trial, on the ground of insanity, the court, if gj m s e - of I9l6 his insanity in any degree continues, must order him to be sent to the ch ^4- house of detention for criminal insane at the Trenton State Hospital or to a county asylum. In case he had legal residence in a county, that county bears its proportion of the expense of maintenance, otherwise the state bears it. The proceedings in committing the criminal insane are the same commitment. as in other commitments. If the judge finds the person in question p -** 6 - insane he must so certify, and order him discharged from imprison- ment and confined in one of the state institutions for the insane, or in a county institution for the insane, until he is restored to reason or removed or discharged. If the person is restored to reason during the pendency of the proceedings, he must be remanded to the place in which he was confined, but not unless the medical direct9r of the institution in which he is confined, presents to the judge a certificate that he has been restored to reason. In cas"e a person confined in state prison appears insane, the same * ws of 1 > l6 ' procedure is followed as in other cases of insanity. If the prisoner * 6 - is found insane, the judge orders his commitment to the state hospital for the district in which he was convicted. If upon re- covery his sentence has not expired, he must be returned to serve out the remainder of it. 162 NEW MEXICO Authority: New Mexico Statutes, 1915 i. ADMINISTRATION AND SUPERVISION a. General. The state is without a board having general super- vision and control of the insane. statutes!' k. Institutional. The state hospital is under the management of 5089. a b oar d of five unsalaried directors, appointed by the governor. The directors are responsible for the buildings and property of the hospital, have the care and custody of all patients, and the dis- 5092. bursement of all moneys.. The president of the board is the chief executive officer. He has general direction of the affairs of the hospital, nominates and with the advice and consent of the board 5096. o f directors, employs all physicians, nurses, guards and other neces- sary employees, and fixes their salaries. The board enacts laws and regulations for the government of the hospital, its employees and inmates, and has power to remove any officer or employee of the asylum. The board has discretionary power in case of absolute necessity to remove patients to the nearest possible safe and ap- propriate place; to regulate the accounts; to examine and audit the expenditure for employees and all other expenses; to make regula- tions and fix the terms upon which insane patients who are not indigent or who are not residents of the territory may be admitted. Jupelintendent. The medical superintendent must be a graduate in medicine and 5 97- have practiced his profession five years after the date of his diploma. 2. CARE a. In state institutions. New Mexico Insane Asylum, Las Vegas; established 1893; 250 beds. b. In local institutions. 3. COMMITMENT SSM>- a. Persons committed. All insane residents of the state are entitled to admission to the state hospital. No case of idiocy., simple feeblemindedness, delirium tremens or mania from drinking may be received, and no person with a contagious or infectious disease. Non- resident indigent insane may not be admitted unless they became insane while within the state. Resident indigent insane have preference in admission. Affidavit. b. Legal procedure in commitment. Whenever it appears, by affidavit, to the satisfaction of a judge of the peace of any county, that a person within the county is so far disordered in his mind as to endanger his health, person or property, he must issue a warrant 163 NEW MEXICO directing the person to be taken before any judge of the district court within the proper district for examination. The judge of the district court must subpoena two or more witnesses, best acquainted with said person, to appear and testify before him at the examina- tion. A subpoena must also issue for at least one graduate of medicine , requiring him to attend the examination. If the physician certifies that the person is insane and that it would be dangerous for him to be at large in the community, and the court is satisfied of the same, he must order the person to be committed to the state hospital. If the person is indigent, the judge must so certify to the board of directors of the hospital. c. Voluntary admission. d. Appeal from commitment. Every person restrained of his H *^ s corpus - liberty may prosecute a writ of habeas corpus to obtain relief from the restraint, if it proves to be unlawful. Application for such writ a591 - must be made by petition to any judge of the supreme court, signed and verified either by the party for whose relief it is intended, or by some person in his behalf. e. Cost of commitment. The cost of examining and transporting an indigent insane person is chargeable upon the county from which he was taken. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Insane persons received into the asylum must be discharged upon 5 98< recovery. (See 3. d. Appeal from commitment; habeas corpus.) 7. COST OF MAINTENANCE When a person declared insane has property of any sort that Pa s r o^g liable " can be subjected to the payment of his care and support at the hospital, the committing court must order proceedings to be taken accordingly. 8. CRIMINAL INSANE A person under indictment' and found insane or who has been acquitted of a criminal charge on the ground of insanity, may be ordered by the court to be kept in strict custody in some place specified by the court while insanity continues. Insane convicts must be received into the hospital and returned so^s. to the penitentiary upon their recovery unless their sentence has expired. 164 insanity La commission. NEW YORK Authorities: Consolidated Laws of New York, 1910 Criminal Code of New York, 1909 Laws of New York, 1911, 1912, 1914, 1917 i. ADMINISTRATION AND SUPERVISION a> General. The state hospital commission consists of three members. One of the commissioners must be a reputable physician of at least ten years' experience in actual practice and five years' experience in the care and treatment of the insane in an institution for this class ; one must be a reputable attorney of not less than ten years' standing and the third a reputable citizen. The commission chooses one of its members as chairman. All three commissioners are salaried officials, the medical commissioner receiving $7,500 per annum and the other two $5,000 each. They are appointed by the governor, the medical commissioner to hold office during good behavior, and the other two commissioners for a term of six years. Any commissioner may be removed by the governor for cause. Attached to the office of the commission is a medical inspector who is charged with the inspection of the state hospitals and especially with the examination of the patients confined in the different hospitals, and who must have at least five years' actual experience in an institution for the treatment of the insane. ^he comm i ss i n ' ls j in general, charged with the execution of the i aws relating to the custody, care and treatment of the insane, but not laws relating to feeble-minded persons, epileptics and idiots. It is required to examine all institutions, public and private, author- ized to receive and care for the insane, and the methods of govern- ment and management of the inmates. The commission has the general oversight and the control of all the property of state hospitals for the insane, and accepts and holds any grant or bequest of mbney or property for the maintenance of any insane person in a state hospital or for other legitimate purpose. The commission must visit every state hospital and every private institution at least twice a year and make necessary recommendations. The matters that the commission must examine and inquire into are specified in detail. The commission is required to meet the board of managers of each hospital at least once a year for the consideration of the management and improvement of the institution. Any member of the commission or the medical inspector may visit any institution where any sick or infirm persons are received or treated for the purpose of ascertaining whether insane persons are confined there 165 NEW YORK without authority. Persons in charge of such institutions must I0 - afford the commission free access and all needed information. The commission makes regulations in regard to correspondence of the insane in custody, and must approve books of record or blank forms for the official use of the hospitals. The commission is required to " submit an annual report to the legislature, including financial estimates for the hospitals. The hospital commission divides the state into as many hospital"Sscts! districts as there are state hospitals, and has power to change their limits. The hospital districts must be so defined that the number of patients in each is in proportion, as nearly as practicable, to the hospital accommodations provided within it. Physicians having obtained certificates as medical examiners in lunacy must file the certificate with the clerk of their county and send a certified copy to the hospital commission within ten days. The commission must keep a record of all medical examiners, and the Tatter are not qualified until they have received from the commission an acknowledgment of the receipt and filing of their certificates. The form of the record of patients to be kept by the commission is prescribed in detail by the law, and all institutions are required to IS< furnish the information called for by the record within a specified l6 - time, as well as information in regard to other necessary matters. The commission is especially charged to provide for the prospec- I7 - tive wants of the poor and indigent insane and for the prevention of over-crowding. It must furnish the legislature each year an esti- mate of the probable number of patients becoming inmates of the respective state hospitals during the ensuing year, and the cost of additional buildings and equipment when such are necessary. No expenditures may be made for additional buildings or extraordinary equipment except upon plans and specifications approved by the commission and the governor. The commission must establish a bureau of deportation for the ^* examination of insane, idiotic, imbecile and epileptic immigrants and I9> alien and non-resident insane, consisting of a medical examiner and such medical or lay deputies as may be necessary, the appointments being made by the commission. The medical examiner of the bu- reau must be a reputable physician of at least ten years' active experi- ence in his profession and-of at least five years' experience in the care and treatment of insane in the hospitals of the state or elsewhere. He receives a salary of $5,000 a year, holds office during good be- havior and is removable by the commission for cause. The com- mission must endeavor to arrange for the continued official recogni- tion of the bureau by the proper authorities of the United States or NEW YORK 166 other states in carrying out its purposes. The bureau must main- tain a careful inspection of the methods and facilities for examining the immigrants with mental diseases at the port of New York and is required to report to the commission from time to time in regard to methods employed, the prevalence of insanity among the immigrants and the foreign born population and to make recommendations in regard to the means by which insane, idiots, imbeciles and epileptics may be deported. It must examine alien and non-resident insane persons in the state hospitals, in other public institutions and else- where in order to determine whether they are suitable cases for deportation under the immigration law or are removable to other places or states. The superintendents of hospitals and institutions must notify the bureau of all such cases coming under their jurisdic- tion and furnish the necessary information. The bureau must notify the authorities in charge of the enforcement of the immigration laws at the port of the entrance of immigrants found to be insane, idiotic, imbecile or epileptic and insane aliens who are or become public charges and arrange for their deportation. The bureau must further notify the commission of the location of non-residents, and the commission must give the bureau the necessary authority for their investigation and removal. Upon the request of any indigent insane persons or .on the written consent of their relatives, legal representatives or qualified friends, the bureau may remove such patients to any country, state or place to which they belong. In making transfers and removals, the bureau is required as far as practicable to employ nurses and must employ female nurses or attendants to accompany female patients unless it is certified by the medical superintendent that they are in condition to travel alone in safety. private* f r Institutions for the care and treatment of the insane for cpmpensa- ins^tutions. ^j on mus t be licensed by the hospital commission. Application for license must be accompanied by a plan of the premises proposed to be occupied, with such other information, and in such form, as the commissiQn may require. The commission may at any time in- vestigate how far a licensed institution is conducted in compliance with the license, and may, if the interests of the inmates of an institu- tion require it, amend or revoke any license granted. !nto e the a care S of When the commission has reason to believe that any person adjudged insane is wrongfully deprived of his liberty, or is cruelly or improperly treated, or inadequate provision is made for his care and safe-keeping, it may order an investigation of the facts, compel the attendance of witnesses and the production of papers, and ex- ercise the powers of a referee in the supreme court. If the order th 92 Dsane ' 167 NEW YORK made by the commission for remedial treatment is just and reason- able, and approved by a justice of the supreme court, it is binding upon any and all institutions to whom it is directed, and any wilful disobedience of it is a crime. When the commission undertakes an investigation into the general management of an institution for the insane, it may give notice to the attorney general, who must appear personally or by deputy and examine the witnesses. The commis- sion may at any time visit and examine inmates of any county or city almshouses to ascertain if insane persons are kept therein. The authorities of each institution for the insane must place on file ^ng'to^ke" t in the office of the institution the recommendations made by the 011 ^ 16 - commissioners as a result of their visits, for the purpose of consulta- tion by such authorities and for reference by the commissioners upon their visits. Justices of the supreme court are authorized to appoint visitors state hospitals, upon nomination of the State Charities' Aid As- sociation. The hospital development commission consists of the state engi- neer, the chairman of the state hospital commission, the state architect, the chairman of the senate finance committee, the chair- ch - man of the assembly ways and means committee, two members appointed by the governor and one^member of the legislature who is appointed by the minority leaders of the senate and the assembly from one of the financial committees of the legislature. The commission has charge of the construction of the state hos- pitals, must adopt a general plan of hospital development, provide for the proper accommodation of surplus patients and make recom- mendations to the legislature. b. Institutional. Each state hospital is under the control of a board of managers, subject to the powers of the commission, consist- ing of seven members, of whom two must be women, appointed by the governor for terms of seven years. If any manager fails to at- tend for six months the regular meeting of his board without due excuse, his place may be declared vacant. The managers, who do not receive any compensation for their J^ti services, have control of all the property and the general direction managers, of the internal affairs of the institution to which they are appointed, subject to the powers of the commission. The rules and regulations must be uniform for all the state hospitals. The superintendent of each hospital is required personally to submit at each monthly meeting of the board a report showing the changes in population, health of patients, officers and employees, accidents, suicides, unusual sickness, etc. NEW YORK 168 Appointment of superin- tendents. Powers and duties of superintend- ents. 45 (I). 45 (12). 48. 49-5<5. The further duties of each board in regard to the general interests of the hospital, maintaining proper inspection, keeping records, holding regular meetings, making reports of the condition of the patients and the institution to the hospital commission and investi- gating all charges made against officers or employees of hospitals, etc., are prescribed in detail by law. The hospital commission has the sole power of appointing the superintendents of the hospitals, but subject to the approval of the board of managers of each hospital. The superintendents must be well educated physicians, graduates of incorporated medical colleges and have at least five years' experience in a hospital for the insane. The commission also has authority to transfer superintendents from one hospital to the other. A superintendent may be removed by a vote of the majority of the board of managers for proper cause, if approved by the commission. Charges of misconduct or incom- petency against any superintendent may be made to the board of managers of the hospital by the commission. The superintendents must have an examination made of each patient within five days after his admission. The superintendent of each hospital has the power to appoint resident officers, including a woman physician and other employees, to remove them for cause, and to prescribe their duties. The commission determines the number of resident officers and employees and may, with the ap- proval of the governor, abolish the office of any of them. The general duties of the superintendents are prescribed in detail. A committee consisting of three superintendents, appointed by the commission, establishes by-laws, rules and regulations governing the appointment and duties of officers and employees of all the state hospitals, and for their internal government, discipline and manage- ment. The by-laws and regulations which must be uniform for all the hospitals are subject to the approval of the commission and the quarterly conference of superintendents and managers with the commission. The several superintendents of the hospitals must hold joint meetings at least once in three months to consult with the commis- sion on matters pertaining to institution management and partic- ularly with reference to the care and treatment of patients. The law specifies minutely regulations in regard to allowances, salaries, and wages; estimates of expenditures; the powers and duties of the treasurer and steward. The hospitals for the criminal insane are under the control of the state superintendent of prisons who appoints the superintendents and subject to the approval of the hospital commission makes rules and regulations for the government of these institutions. 169 NEW YORK 2. CARE a. In state institutions. Utica State Hospital, Utica; established 1836; 1,671 beds. Matteawan State Hospital, Beacon; established 1855; 887 beds (for criminal insane). Willard State Hospital, Willard; established 1865; 2,397 beds. Hudson River State Hospital, Poughkeepsie ; established 1867; 3,409 beds. Middletown State Homeopathic Hospital, Middletown; estab- lished 1870; 2,235 beds. Buffalo State Hospital, Buffalo; established 1870; 2,171 beds. Binghamton State Hospital, Binghamton; established 1879; 2,746 beds. St. Lawrence State Hospital, Ogdensburg; established 1886; 2,252 beds. Central Islip State Hospital, Central Islip; established 1889; 5,000 beds. Rochester State Hospital, Rochester; established 1891; 1,627 beds. Kings Park State Hospital, Kings Park; established 1895; 4,373 beds. Brooklyn State Hospital, Brooklyn; established 1895; 864 beds. Gowanda State Homeopathic Hospital, Collins; established 1896; 1,287 beds. Manhattan State Hospital, Ward's Island, New York City; established .1896; 5,004 beds. Dannemora State Hospital, Dannemora; established 1899; 550 beds (for insane convicts). The state sychiatric pinstitute is located on Ward's Island, New York City. b. In local institutions. There are no local public institutions for the insane, although there are maintained in several cities, e. g. Albany, Brooklyn, New York, and Syracuse, psychopathic hospi- tals or psychopathic wards in connection with general hospitals where the insane are received for observation and treatment. If the cases appear to be chronic or of long duration, they are com- mitted from these psychopathic wards or hospitals to the district state hospital. A psychopathic hospital has also been established at the state reformatory for women. Insane persons may not be p rUw - committed to an almshouse. 3. COMMITMENT a. Persons committed. All insane persons, not idiots, who are 8o - residents of the state and citizens are entitled to admission to the state hospitals for the insane. Epileptics and feeble-minded persons becoming insane may be committed to a state hospital. The commission may authorize the superintendent of a state 8 - hospital to admit under special agreement insane persons who are NEW YORK 170 residents of the state, other than poor and indigent, when there is room for them. No such patient is permitted to occupy more than one room in any state hospital. The payment of the cost of main- tenance must be secured by a surety company bond. The com- mission has power to demand the removal of such patients to duly licensed private institutions. *> b. Legal procedure in commitment. A person alleged to be insane, who is not confined upon a criminal charge, may be com- mitted to an institution for the insane by an order made by a judge of a court of record of the city or county, or a justice of the supreme court of the judicial district, in which he resides, upon a certificate by two qualified medical examiners in lunacy, accompanied by a verified petition, or upon such certificate and petition after a hearing to determine the question. The hospital commission furnishes blanks for such certificates and petitions. An insane person may be committed only to a state hospital, a duly licensed institution for the insane or the hospitals for the criminal insane, or to the care and custody of relatives or a committee. phys^ans 8 f ^he certificate of lunacy must be made out by two reputable 8l - physicians graduates of- an incorporated medical college, who have been in actual practice at least three years, and have filed with the commission a copy of the certificate of a judge of a court of record, showing such qualifications in accordance with the forms prescribed by the commission. The physicians must jointly make a final examination within ten days before the order is granted. The certificate must contain the facts and circumstances upon which the judgment of the physicians is based and state that the condition of the person requires care and treatment in an institution for the insane. Neither of the physicians may be a relative of the person or have any interest in the institution to which it is proposed to com- mit him. Wh i on for com _ Any person with whom ar> alleged insane person -lives, or his insane" 4 f the near relatives, or the next of kin available, or the committee of his person, or an officer of any well-recognized charitable institution, and any overseer or superintendent of the poor, may apply for an order of commitment by presenting a verified petition containing a statement of the facts in the case, accompanied by the prescribed certificate of lunacy of the medical examiners. Notice of the ap- plication must be served personally upon the person alleged to be insane at least one day before it is made; and if made by an overseer or superintendent of the poor, notice must also be served upon the relatives of the alleged insane person or if relatives are not known, then upon the person with whom he resides. 171 NEW YORK If no demand is made for a hearing on behalf of the alleged insane ^f^ e person, the judge may proceed to determine the question of in- sanity, and if satisfied that he is insane, may immediately issue an order for his commitment. But if it appears that he is harmless and that relatives or a committee are willing and able to care for him at some other place, the judge may order him placed in the care of the relatives or committee. The judge may require other proofs in addition to the petition and medical certificate. Upon demand, or upon his own motion, the judge may direct hearing to be held on application within five days, at which he must hear the testimony and examine the alleged insane person if deemed advisable, in or out of court. If the person is found insane, the judge must forthwith order him committed to an institution for the insane or make other provision. If the judge can not hear the ap- plication himself, he may name some referee to hear the testimony and report to him. The order of commitment to a state hospital ^ must be accompanied by a written statement of the judge in regard to the financial condition of the insane person and persons liable for his support. The superintendent of the hospital must be notified of the commitment and at once make provision for the transfer of the insane person to the hospital. The petition of the applicant, the certificate of the medical exam- Documents to iners, the order directing a hearing, if one be issued, and the decision of ^ s ^ tendent the judge or referee, and the order of commitment must be presented . at the time of the commitment to the superintendent of the institu- tion and copies forwarded by him to the state hospital commission. The same obligations in regard to the papers in the case rest upon relatives or committee to whose care an insane person is committed. The superintendent of any institution for the insane may to receive a person committed if the papers do not comply with the above provisions, or if, in his judgment, the person is not insane within the meaning of the statute, or if received, he may be dis- charged by the commission. No person may be admitted to any such institution after the expiration of ten days from the date of the order of commitment. If an insane person needs immediate care and treatment, or is dangerously insane, he must at once be received by a state or licensed 8a - institution authorized by law to care for the insane on a certificate of lunacy executed by two medical examiners in lunacy after ex- amination upon the presentation of a proper petition, but may not be retained for a period exceeding ten days. Prior to the expiration of this time, an order for his commitment must be obtained as provided by law. The superintendent of any institution may refuse, to receive an insane person upon such certificate and petition if, in NEW YORK 172 his judgment, the reasons alleged are not sufficient, or if the condition of the patient is not of such a character as to make it necessary that he should receive immediate treatment. ioca! e officers County superintendents and overseers of the poor, health officers SelnsaJJ axic * otners having to do with the poor must see that indigent insane 8 7- persons are timely granted the necessary relief. They must notify the proper health officer of the presence of the insane person, who must see that proceedings are taken for his examination and com- mitment to a state hospital. When directed by the health officer, it is the duty of the poor officer to make application for the person's commitment. Pending the examination, commitment and delivery to the hospital, the health officer must see to it that the insane person is properly cared for. In the boroughs of Manhattan and the Bronx, the duties prescribed in this paragraph devolve upon the trustees of Bellevue and Allied Hospitals, and in the other boroughs of New York City and in the county of Albany upon the commis- sioner of public charities. The trustees of Bellevue and Allied Hospitals, or the commissioner of public charities of New York City or of Albany county, must see that proceedings are taken to determine the mental condition of any person from their locality who is reported insane and when necessary that his commitment to an institution for the insane is secured; provided that the report is made by one with whom the alleged person lives, or a near relative or a licensed physician or a peace officer or by a representative of an incorporated charitable society. When it is reported to the above authorities that an appar- ently insane person resides within their respective boroughs, they must send a nurse or a medical examiner in lunacy, attached to the psychopathic ward of their institution to see the alleged insane person. If, in the judgment of the chief resident alienist of the respective psychopathic wards or of the medical examiners, the person needs immediate care and treatment or should be placed under observation, he must be removed to the psychopathic ward, ' for not over ten days, due notice being given his relatives. When a person has been ordered committed, the local officials must have him transferred without unnecessary delay to a proper state hospital. In no case may an insane person be confined in any other place than a state hospital or licensed private institution for the insane for more than ten days, nor be committed as a disorderly person to a prison for criminals. The local authorities may provide a plan for the temporary care of alleged insane persons, subject to the approval of the commission. An apparently insane person may be arrested if disorderly by any peace officer who must notify the proper authorities at once. In 173 NEW YORK New York City a magistrate may, upon proper information, issue a warrant for the apprehension of an apparently insane person. If the person appears upon arraignment to be insane the magistrate must commit him to the custody of the trustees of Bellevue and Allied Hospitals or to the commissioner of public charities, as the case may be, who shall take measures for the determination of his mental condition. When an insane person has sufficient property to maintain himself ^^ rary or those liable for his support are able to do so, and he is dangerously dangerous insane, the committee of his person and estate or his relatives must 88 - provide a suitable place for his confinement, subject to the approval of the local health officer. The local health officers, or in the boroughs of Manhattan and the Bronx (New York City), the board of trustees of Bellevue and Allied Hospitals, and in the boroughs of Brooklyn, Queens and Richmond (New York City), and the county of Albany, the commissioner of public charities are required to see that the above provision is complied with in the most .humane and speedy manner. If the committee of his person or relatives refuse or neglect to care for the insane person, application must be made by the officials, named to a judge of a court of record of the city or county, or a justice of the supreme court of the judicial district in which such insane person may reside, for his apprehension and confinement. Unless an order of commitment has been previously granted, application must be made by the officers named for his commitment to the proper institution and they must take the necessary legal steps to have him sent to such institution. Pending transfer the officers in question must have the insane person cared for in a suitable place and provided with proper medical care and nursing. Any person needing immediate care and treatment because of jj^,Jg2Ji, by mental derangement other than delirium tremens or drunkenness 82, sec. 2. may be admitted to a state hospital on the written request of a health officer on an approved form. Unless the patient signs a request to remain as a voluntary patient he must be examined and committed in the usual way within ten days. The superintendent may refuse to receive a patient who is deemed by him not suitable for such care. c. Voluntary admission. The superintendent of any state hospital ^ T ^ ad ~ or licensed private institution for the insane, except the Matteawan admit, and Dannemora State Hospitals may, subject to the regulations of the state hospital commission, receive and retain as a patient any suitable person who voluntarily makes written application for admis- sion, and whose mental condition is such as to render him competent to make it; but he may not be detained for more than ten days after having given notice of his intention or desire to leave the hospital. NEW YORK 174 Within three days after the admission of a voluntary patient the superintendent of a state hospital must send a record of the patient to the state hospital commission. The superintendent in charge of a licensed private institution for the insane must furnish the medical commissioner or medical inspector a complete list of all voluntary cases since his last visit. The commissioner or inspector must ex- amine such cases and determine whether they belong to the volun- tary class. His decision as to their commitment or discharge must at once be complied with. Failure to conform with these require- ments is sufficient cause for the revocation of the license of a private institution. proceedings d. Appeal from commitment. If a person ordered to be commit- comn^tment. ^ e( ^' or anv one representing him, is dissatisfied with the order of the 83 - judge, he may within thirty days after the order is made, obtain a rehearing and review of the proceedings upon petition to a justice of the supreme court other than the justice making the order of com- mitment. The justice must summon a jury and try the question of the insanity of the person committed. If the petitioner is other than the person committed, or his near relative, or the one with whom he resided, security must be furnished for payment of the costs of the proceedings. If the person is found to be sane, he must forthwith be discharged, but if insane, the justice must certify the fact and order recommitment as upon the original hearing. If a judge or justice refuses to grant an application for an order of commitment" of an insane person proved to be dangerous to himself or others, he must state his reasons for refusal in writing, and any person aggrieved thereby may obtain a rehearing and review, and a determination of the question of insanity by a jury. 93. Any one held as insane is entitled to a writ of habeas corpus, on application made by him or by a friend. At the hearing, the medical history of the patient must be given in evidence, and the superintend- ent or medical officer in charge must testify under oath. to orwunty. e - Cost of commitment. The cost of determining the insanity of an indigent person and in securing his admission to a state hospital, including the expense of proper clothing, medical care and nursing, is a charge upon the town, city or county securing the commitment. ment burse ~ ^ ^e P erson ^ s n t indigent, the cost paid by a town, city or county may be collected from his estate or from the persons liable for his maintenance. 4. CONVEYING PATIENTS TO THE HOSPITAL Attendant. The hospital to which a patient is committed must send a trained attendant to bring him to it. Each female patient must be ac- companied by a female attendant, unless accompanied by her father, 175 NEW YORK brother, husband or son. The commission may prohibit the employment of an attendant it deems unfit. 5. TRANSFER OF PATIENTS In case of over-crowding or for other reasons, the state hospital s y the hospital commission may order the transfer of patients from" one state co ^ uss hospital to another, at the expense of the state. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of a state hospital may grant a parole to a Parole of patient not exceeding one year, under the general conditions pre-Laws oit 1917, scribed by the commission, during which time the hospital is not liable for his expenses, which are then a charge upon the committee or person to whom he is paroled. The superintendent of a state hospital, on filing his written cer- Discharge of tificate with the commission, may discharge any patient, except "* one held upon an order of the court having criminal jurisdiction in an action or proceeding arising out of a criminal, offense, as follows: (1) a patient who has recovered; (2) a patient who is a dotard, not insane; (3) any patient who has not recovered, but whose discharge will not be detrimental to the public welfare or injurious to himself; provided that the superintendent is satisfied that friends or relatives of the patient are willing and able properly to care for him after discharge. When the superintendent is unwilling to certify to the discharge when court of an unrecovered patient, any judge of the court of record in the discharge, district in which the hospital is situated may inquire into the case and, upon proofs, having accorded the superintendent a hearing, direct the discharge of this patient, upon such security as he may require. The commission may discharge any patient who, in its judgment, Discharge is improperly detained in any institution. Poor and indigent persons discharged by the superintendent as idiots, dotards, or as epileptics, not insane, or because not proper cases for treatment, must be received and cared for by the superintendent of the poor or other authority having similar power in the county from which he was committed. A patient held upon an order of a criminal court in an action arising from a criminal offense may be discharged upon the superintendent's certificate of recovery, approved by the court. No patient may be discharge or paroled from a state hospital without suitable clothing and money. If they can not be otherwise ^ S 20 of 191 obtained, the steward must, upon the order of the superintendent furnish the clothing and money, not exceeding twenty-five dollars, to defray his expenses until he can reach his relatives or friends or find employment. NEW YORK 176 The superintendent of a licensed private institution may parole a institution 36 * 1 P a tient for not more than one year, under conditions prescribed by Laws of 1917, the commission. He may discharge, on filing his certificate with the commission, a recovered patient or one who has not recovered if it is not detrimental to public welfare or injurious to the patient. The superintendent, subject to the approval of the commission, may apply for the transfer of a patient to a state hospital whom he re- fuses to discharge and for whom relatives or friends refuse to provide care and treatment. todTent * Poor and indigent persons committed to a state hospital who have insane Sident n0 ^ a ^ e S a ^' settlement in the state of New York may be returned by insanity Law. the hospital commission, either before or after their admission to a state hospital, to the country or state to which they belong upon an order issued by any judge. 7. COST OF MAINTENANCE i'7, All poor and indigent insane persons, not in confinement under criminal proceedings, committed to state hospitals, are wholly supported by the state. The cost of transfer of patients to state hospitals is a charge upon the state. The hospital commission must secure from the patient's estate and from relatives or friends liable or willing to assume the costs of support, reimbursement at the rate fixed by the commission, in whole or in part. The commission may waive the whole or a portion of the claim of the state against the estate of a patient, when the court by which the committee was appointed has directed the committee to apply any part of the patient's estate for the maintenance of his family. The commission may appoint agents to secure from relatives and friends who are liable or willing to 'assume the cost of support reimbursement, in whole or in part. The commission may fix the rate to be paid for the support of an inmate of a state hospital by the committee of the patient or by relatives liable for his support or by persons willing to assume the cost. The maintenance of -any inmate of a state hos- pital, committed upon a court order arising out of any criminal action, must be paid by the county from which the inmate was committed. The father, mother, husband, wife or children of an insane person if of sufficient ability and his guardian, if the estate is sufficient, must maintain him. 8. CRIMINAL INSANE ^ tne defense f insanity is made in a criminal case, and the jury acquit the defendant on that ground, the court may order him com- mitted to a state hospital until he becomes sane. 177 NEW YORK If the court believes a defendant to be insane the question of his 481. insanity must be tried; and if he is found insane, he must be com- mitted to a state hospital. When a defendant pleads insanity, the court may appoint a com- 6 s 8 - mission of not more than three disinterested persons to examine him and report as to his sanity. The same procedure may be taken in case the defendant is in confinement under indictment and appears to be insane. In either case, the commission must at once make examination, to be attended by the district attorney, and the counsel of the defendant may take part in the proceedings. If the commission finds the defendant insane, and the court deems 6 sp. his discharge dangerous, the judge must order him committed by the sheriff to a state hospital, and to be delivered by the superintendent 66r - to the sheriff upon his recovery, in which case the superintendent must notify the judge of the circuit court of the district in which the hospital is situated, whereupon the defendant must be brought back to trial, judgment, execution, or be legally discharged. The expenses in such cases are chargeable upon the county from 66a - which he was sent, which may, however, recover from the estate of the defendant or from a relative, town, city or county, bound to provide for him. Whenever trie physician of the state prison for women, of any Commitment of . - * misdemeanants county penitentiary or workhouse, of any reformatory for women, or whei * iasane. of the state reformatory or of any other penal institution, reports that a person undergoing a sentence of one year or less or convicted of a misdemeanor, or any female convict, is insane, the warden may apply to a judge of a court of record for an examination of the person by two legally qualified examiners in lunacy, other than the physician connected with the penal institution where the alleged insane person is in confinement. If the examiners in lunacy are satisfied that the convict is insane, the warden must apply to a judge of a court of record for an order transferring the person to the Matteawan State II0 - Hospital. This hospital is established for the purpose of caring for insane persons committed by the criminal courts or transferred to it by the state hospital commission and for convicted persons who are declared insane while undergoing sentence for a year or less or for a misdemeanor and for all female convicts. When a convict in the Matteawan State Hospital is found i at the expiration of the term for which he was sentenced, he may be JJ retained until he has recovered or is otherwise legally discharged. " The medical superintendent of the hospital may discharge and de- liver any patient whose sentence has expired and who is still insane but for whom it is safe to be at large, to his relatives or friends who are able and willing to maintain him without further public charge. 13 NEW YORK 178 Transfersof of the i4 9 terms ' oMerms piration w ^ * When a convict recovers who has been retained in a hospital as insane beyond the expiration of his sentence, the superintendent may discharge him, and the convict is then entitled to the sum of ten dollars, suitable clothing and a railroad ticket to his county. Any convict whose term of imprisonment has expired and who has not recovered may be transferred to a state hospital on the order of the commission. The state hospital commission may order any insane inmate of a state hospital to be transferred to the Matteawan State Hospital, who has been committed upon the order of a court of criminal jurisdiction; it may also order such transfer of any person who has previously been sentenced to a term of imprisonment in any penal institution and who still manifests criminal tendencies, or any patient who has previously been an inmate of the Matteawan State Hospital. The Dannemora State Hospital is for male prisoners only who have been confined in state prisons, reformatories or penitentiaries for a felony. When the physician of any one of the above mentioned penal institutions certifies to the warden that a male prisoner is insane, the warden must have him transferred to the Dannemora State Hospital, to be retained there until legally discharged. When a convict in the Dannemora State Hospital, whose term has expired, continues insane, the medical superintendent must apply to the judge of a court of record for the examination of the convicl by two physicians qualified as medical examiners in lunacy, other than the physician of the hospital. If the examiners ap- pointed by the court are satisfied that the convict is insane, they must certify to the fact in the manner prescribed for the commit- ment of insane to state hospitals. The judge, if satisfied that the convict continues insane, must order the superintendent to retain him until discharged as provided by law. A convict whose sentence has expired and who is still insane, but reasonably safe to be at large may be discharged to relatives or friends able and willing comfortably to maintain him without further public expense; and such convict may be given the whole or a portion of the allowances granted to recovered convicts. When a convict recovers who has been retained beyond the ex- piration of his sentence because of insanity, he*may be discharged and is then entitled to ten dollars, suitable clothing and transpor- tation to the county of his conviction or other place he may desig- nate at no greater distance. Any unrecovered convict in the hospital whose term of imprison- ment has expired may be transferred to any institution for the insane upon an order of the state hospital commission. 179 NEW YORK Strict rules are established to prevent unauthorized communica- tion with or by convict patients, but letters written by the latter to the county judge or district attorney of the county from which they were sentenced must be forwarded after examination by the medical superintendent. 180 NORTH CAROLINA Authorities: Pell's Revisal of the Laws of North Carolina, 1908 Session Laws, 1915, 1917 i. ADMINISTRATION AND SUPERVISION dmrirtes public a * General. The board of public charities is composed of five P 3^13 members, recommended by the governor and elected by the concur- 3914. rent vote of the general assembly for terms of six years. The board must investigate and supervise the whole system of charitable and 3918. penal institutions of the state and report biennially to the general 39I9> assembly. When the board believes that any curable insane person is not properly cared for in an almshouse or other place, whether he is a public charge or not, it must have him removed to a state hospital 3920. f or the insane. The board may at any time request reports from the 4600. superintendents or other officers of charitable institutions and any desired statistics. Private hospitals for the care of the insane must be licensed by the board and are subject to its inspection and super- vision. The board of internal improvements consists of the governor and two others appointed by him. They have the duty of investigation of public institutions. directors ^ ne s ^ a ^ e hospitals for the insane are under the management of a chTso f I9I7> general board of directors consisting of nine members, no two of whom may be residents of the same county, appointed by the gov- ernor for terms of six years. They receive four dollars a day and P '67 expenses while engaged in official duties. The board directs and manages the affairs of the three hospitals, appoints the superintend- ents and fixes the salaries of all officers and employees. A meeting must be held at each institution at least once each year and at such other times as necessary. Biennial reports must be made to the legislature. committee 5 ^ co-operative purchasing committee, called "the committee," IpI7> cons i s ti n g of the superintendents of six of the larger state institu- tions and including the three state hospitals for the insane, meets at least four times a year, three members constituting a quorum, to make such rules and regulations as it deems necessary for the economical purchase of supplies for the state institutions repre- sented. Other state institutions not represented on the committee must report to it regarding all supplies purchased by them, and may request the committee to purchase their supplies. The committee reports quarterly to the governor and publishes an annual report. 181 NORTH CAROLINA b. Institutional. Three members of the general board of directors SjJjSJjj^M are appointed from the Morganton hospital district, three from the ^* w * o of w> Raleigh hospital district, and three from the state at large. The members from each district constitute the executive committee for the hospital of the district, and the three members appointed from the state at large are the executive committee for the hospital for the insane at Goldsboro. The superintendent must be a skilled Superintendent, physician of good moral character, and holds office for six years, 4561. subject to removal by the board for cause. The superintendent has 4562. exclusive control of the subordinate officers and employees he ap- 4564. points and may remove them for cause. The state hospital for the dangerous insane is under the manage- ment of the board of directors of the state prison. 2. CARE a. In state institutions. State Hospital, Raleigh; established 1856; 1,000 beds. State Hospital for the Insane, Morganton; established 1880; 1,360 beds. State Hospital at Goldsboro, Goldsboro; established 1880; 860 beds (for negro patients). State Hospital for Dangerous Insane, Raleigh; established 1898; 70 beds. b. In local institutions. Any county, city or town may establish 46oi- a hospital for the care of insane persons who can not be admitted to a state hospital. Otherwise such insane, when chargeable upon the county, may be provided for in the county homes which are under the control of the board of commissioners of each county. 3. COMMITMENT a. Persons committed. All insane persons, except idiots, who 4573. are citizens and residents of the state are entitle to admission to the state hospitals ; but admission may be refused persons who recently have been exposed to contagious or infectious disease. b. Legal procedure in commitment. Some respectable citizen, Affidavit, residing in the county of the alleged insane persons must file an affidavit with a clerk of the superior court of the county that the person in question is a fit subject for admission to a state hospital. 4577. The clerk may then have the alleged insane person brought before him or go to his residence, and examine into the condition of his mind, with the assistance of the county physician and the advice of other reputable physicians. He must take the testimony of at least one recognized physician, resident of the state, and if possible, Hearing, of a member of his family or friend. If the clerk decides that such NORTH CAROLINA 182 4583. Alien insane how dealt with. 4585. Indigent patients to have priority. 4573- Committed inebriates found insane. 4607. person is insane, and some friend will not give bond guaranteeing his good behavior and to keep and support him until the cause for confinement ceases, the clerk must order his removal to the proper hospital, and submit to the board of directors the examination of the witnesses. In an emergency, the examination may be made by a justice of the peace, who is required to report to the clerk of the superior court. But the order for commitment must be issued by the clerk. In cases of great emergency, a justice may admit a patient to a hospital, but must procure an order from the clerk to the superintendent within thirty days. Whenever any citizen or resident of the state becomes suddenly or violently insane in some county other than that of his settlement, the proper authorities of any county in which he is have authority to examine him, and to commit him to the hospital to which he would be sent had he been committed from the county of his own settlement. Transcripts of the proceedings in such cases must be sent to the clerk o*f the county in which he is settled, in order that all the costs of examination and commitment may be borne by the proper county. If a citizen or resident of another state is found to be insane, the clerk of the superior court must notify the governor of the state in which the insane person is a citizen; and, for a reasonable length of time, the insane person must be kept in restraint, but must not be committed to any state hospital. If no provision is made by his own state for removal within a reasonable time, the county com- missioners of the county in which he was found insane must send him to the state in which he is a citizen, and deliver him to the proper authorities. No person who has moved into the state while insane may be deemed a resident. Knowingly to commit a non- resident to a hospital for the insane is a misdemeanor. When an alien is ascertained to be insane, the clerk of the superior court must immediately notify the governor of his state of all the facts and transmit a copy of the examination taken. This informa- tion and examination must thereupon be transmitted to the federal authorities with a request for the deportation of the insane person. In the admission of patients to any state hospital, priority must be given to the indigent insane, with due regard to the curability of patients, and the exigencies of particular cases. It is permissible, however, to admit other than indigent patients if there be sufficient room. Inebriates of both sexes may be admitted to hospitals for the in- sane, but not without pay; and not more than twelve of each sex. Inebriates are committed in the same manner as the insane, except that the admission of every inebriate is for a specified time, not exceeding twelve months and not less than three months. If any 183 NORTH CAROLINA inebriate while under treatment at a hospital is found to be in- sane, he must be detained and -treated as any other insane person under order of the board of directors, due report having been made to the clerk of the proper county. c. Voluntary admission. Provision is made for the voluntary 4593. admission of patients. An application for voluntary admission must be accompanied by the certificate of a licensed physician stating that the applicant is a fit subject for admission. No certif- icate of the clerk of the superior court is necessary. A voluntary patient is not entitled to a discharge until he has given the superin- tendent ten days' notice of his desire to be discharged. d. Appeal from commitment. Every person restrained of his Habeas corpus, liberty is entitled to an inquiry as to its lawfulness and to have the same removed if unlawful. e. Cost of commitment. The cost of committing a patient to a 4555. hospital or removing him must be paid by himself if the board of county commissioners are satisfied that he has sufficient property, or by any person liable for his support or maintenance, or by the county in which he has a legal settlement. If any person is found to possess sufficient property to support those who may be legally dependent upon his estate, he may be placed in any hospital without the state or in a private hospital, instead of in a state hospital; it is lawful to place him in the house he has chosen. 4. CONVEYING PATIENTS TO THE HOSPITAL The superintendent of the hospital to which a patient has been La ws of 1915. committed provides an attendant to convey him and renders a bill for cost of transportation to the board of commissioners of the county. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS Each superintendent may, for the space of thirty days or until BJ e ^ tendent the next meeting of the board of directors, discharge any patient P-*^ upon probation if, in his opinion, it will not be dangerous to do so. A report of any such probation must be made to the board of discharge. It is the duty of the board of county commissioners, by proper B y the . county * commissioners. order, to discharge any ascertained insane person in their county, 4595. not admitted to the appropriate hospital, and not committed for crime, when it appears upon the certificate of two respectable physi- cians that such insane person ought to be discharged if in a hospital. If the superintendent of the hospital doubt the propriety of the 4M 6 - admission of patients, he may place the matter before a board con- sisting of any three directors of the hospital. If such board so NORTH CAROLINA 184 decide, the person in question shall be received into the hospital, but a like board may at any time thereafter discharge him to any friend who will become surety for his conduct, and proper care. Any three of the board of directors of a hospital may, upon the certification of the superintendent, discharge from the hospital any person admitted as insane, when he is found to be sane, or has recovered, or is an incurable who can safely be allowed at liberty, or the board may release such a person to the county of his settle- ment on probation. The board may discharge or remove an insane person upon other sufficient causes. 7. COST OF MAINTENANCE Parties liable. Indigent insane patients are supported in hospitals at the ex- pense of the state. An insane person, who is able to pay expenses, is not entitled to free admission, and the superintendent has no power to bind the state to support him. 8. CRIMINAL INSANE Treated as All persons committing crime while insane, who therefore can not insane. be tried for their offense, are to be treated as dangerous insane. When a person confined as dangerous insane and against whom indictment for crime is pending has recovered, it is the duty of the superintendent of the hospital to notify the clerk of the county, who shall take the case to the superior court of his county for trial, and the person must not be discharged without an order from the court. 4618. Persons accused of capital crimes and certain other grave offenses, who escape indictment or who are acquitted on the ground of insanity must be committed to the hospital for the dangerous insane. In the event of their recovery, it is the duty of the sheriff of the county from which they came to take them before the judge of the superior court of the district to be dealt with according to law. Discharge. No person acquitted of capital felony on the ground of insanity and committed to the hospital for the dangerous insane may be discharged except by authorization of the general assembly. A person acquitted of crime of a lower degree than a capital felony must not be discharged except upon an order from the governor. In other cases the consent to the discharge of the judge of the district is necessary. Laws of ipn, When a person who has been confined in the state's prison for felonious murder, and who has been discharged at the expiration of his sentence, or as the result of executive clemency, thereafter so acts as to justify the belief that he is possessed of a homicidal mania, and is duly adjudged insane, the clerk of the superior court or other officer having jurisdiction of the proceedings may, in his discretion, 185 NORTH CAROLINA commit him to the state hospital for the dangerous insane, or to one of the other state hospitals for the insane. A convict in the state prison becoming insane must be admitted to the hospital for dangerous insane. If still insane at the expira- tion of his sentence, he must be held until he becomes sane or is considered harmless and incurable. 186 NORTH DAKOTA Authorities: Compiled Laws of North Dakota, 1913 Laws of North Dakota, 1915, 1917, 1918 i. ADMINISTRATION AND SUPERVISION Board of con- a General. The board of control of state institutions consists of three members appointed by the governor, with the consent of the senate for terms of six years. The chairman of the board is desig- nated by the governor for each biennial period. The members receive a salary of $3,000 per annum and expenses, and are subject to removal by the governor. The board is charged with the management of the charitable and correctional institutions of the state, and with the investigation of the methods of caring for the insane, delinquent, and criminal classes. C 243! ledLaws ' The board of control manages and controls the state hospital for the insane, and makes all by-laws and regulations necessary for its government. o^insaiSy. 6 " The commissioners of insanity (see 3b.) in each organized county are responsible for the safe-keeping of the insane in their respective counties. supermtendent. b Institutional. The superintendent of the hospital is appointed by the board of control. He must be a physician of acknowledged skill and ability, a graduate of a reputable medical college; and must give a bond to the state for $10,000, conditioned for the faith- ful discharge of the duties of his office, to be approved by the board. In addition to having the entire control of the medical, moral and dietetic treatment of the patients, he appoints all employees and assistants necessary for the institution except the steward and matron, who are appointed by the board of control, and may dis- charge any of these employees at will and suspend any resident officer of the hospital, except the steward, being responsible to the board for the proper exercise of this power. 2. CARE a. In state institutions. North Dakota State Hospital for the Insane, Jamestown; estab- lished, 1883; beds, 750. b. In local institutions. The county commissioners, who are the overseers of the poor, must provide for the indigent insane of their respective counties who can not be received at the state hospital, and may care for them in the county asylum when one has been established. 187 NORTH DAKOTA 3. COMMITMENT a. Persons committed. All resident insane of the state who are f w. not idiots are entitled to receive care and treatment at the state hospital. Residents of other states may be admitted to the hospital '7 61 - upon payment of the cost of board and treatment, but not to exclu- sion of resident insane. b. Legal procedure in commitment. In each organized county commssioneis there is a board, consisting of three persons, known as "commis- Z 547. sioners of insanity." The county judge is a member of the board and its chairman. The other two members are appointed by the board of county commissioners, one of whom must be a reputable practicing physician and the other a reputable practicing attorney, the term of appointment being for two years. In case of the tem- porary absence of the commissioners or their inability to act, the county judge calls to his aid a reputable practicing physician or attorney. The commissioners have cognizance of all applications 2 S4p. for admission to the hospital. They have power to issue subpoenas and to administer oaths. Applications for admission to the hospital must be made in ing, verified by affidavit, alleging that the person in whose behalf the application is made is believed to be insane and needs custody and treatment in the hospital for the insane. The commissioners must at once investigate the grounds for the application and may require the person for whom admission is sought to be brought before them for examination. Any citizen of the county or any relative of the person alleged to be insane may appear and resist the application, and the parties may appear by counsel. The com- missioners, whether they decide to dispense with the presence of the person alleged to be insane or not, must appoint some regular practicing physician of the county, who may be of their own number, to make a personal examination of him. The physician appointed must certify that he has made a careful personal examination, and that he finds the person insane or not insane. In connection with the examination, the physician must endeavor to obtain from the relatives of the person, or from others, correct answers to the inter- rogatories required by the law. If the commissioners find the person insane and a proper subject for treatment at the hospital, they must authorize the superintendent to receive him. If it becomes necessary, for want of room or other cause, to criminate in the reception of patients into the hospital, a selection w^ must be made as follows: (1) cases of less than one year's duration; (2) chronic cases of more than one year's duration presenting the most favorable prospects for recovery; (3) those for whom applica- NORTH DAKOTA 188 When accom- modations of hospital are insufficient. 2554. Insane persons cared for by county. 2568. Insane not to be restrained of liberty except by authorities. 2557- Non-resident insane. 2561. Proceedings for release. 2562. tion has been longest on file; (4) when cases are equally meritorious in all other respects, the indigent are to be preferred. When persons found to be insane can not at once be admitted to the hospital nor safely be allowed at liberty, the commissioners must require them to be suitably provided for otherwise until admission can be had, or until the occasion therefor no longer exists. If such a person is to be cared for without public charge, the commissioners must appoint a special custodian for hjm. In the case of public patients, the commissioners must require that they be cared for by the overseers of the poor. If there is no poorhouse for their recep- tion, or no more suitable place can be found, they may be confined in the county jail; or the commissioners, in their discretion, may require them to be taken to a hospital of any state that may be designated by the governor, who is authorized to make the best terms he can for the admission of such patients. On application to the commissioners on behalf of persons alleged to be insane and whose admission to the hospital is not sought, asking that provision be made for their care as insane, either as public or private charges, within the county, the commissioners, on proof of their insanity, may provide for them as in other cases. Insane persons who have been under care, outside of the hospital, may on application be transferred to the state hospital whenever they can be admitted thereto, on the warrant of the commissioners. Such admission may be had within six months without another inquest, unless the commissioners deem a further inquest advisable. No person supposed to be insane may be restrained of his liberty by any other person except by authority obtained as herein required, save to such extent and for such brief period as may be necessary for the safety of persons until proper authority can be had. Any person found by the commissioners of insanity to be insane who has no legal residence within this state must be sent, at the expense of the state, to the place where he belongs when it can be ascertained . c. Voluntary admission. d. Appeal from commitment. On a statement in writing, verified by affidavit to the county judge of the county in which the hospital is situated or of the county in which any person confined in the hospital has his residence, alleging that a person is not insane and is unjustly deprived of his liberty, the judge must appoint a com- mission of not more than three persons to inquire into the merits of the case, one of whom must be a physician; and if two or more are appointed, one must be an attorney. Their report to the county judge must be signed by the superintendent. Before finding the person sane, the judge must notify the nearest relative or friend and 189 NORTH DAKOTA all who testified at the hearing at which*the person was found insane, to appear before him within five days and give testimony. If, on their report, the county judge finds the person sane, he must order his discharge; if not, he must authorize his continued detention. The commission so provided for may not be repeated oftener than 2 s63. once in six months for the same person, and no commission may be appointed in the case of any patient within six months of the time of his admission. All persons confined as insane are entitled to the benefit of the H *^* s corpus - writ of habeas corpus. If the judge decides that a person is insane, this is no bar to the issuance of the writ a second time whenever it is alleged that he has been restored to reason. e. Cost of commitment. The expense of committing an insane atl by the person to the hospital, including the fees to the commissioners of 2s6s- insanity, the judge and the examining physician, is paid out of the county treasury; but the fee and expenses of the sheriff for conveying a patient to the hospital, or to the authorities of another state, are paid out of the state treasury. 4. CONVEYING PATIENTS TO THE HOSPITAL A state transportation agent or his deputy has the duty of con- Jgent sp rtation veying insane persons to the hospital. A female taken to the hos- ch.^s! I9 ' 5 ' pital must be attended by some other female or some relative. The superintendent, in his acknowledgment of delivery, must state whether there was any such person in attendance. If any relative or intimate friend of the patient, who is a suitable person, requests it, he has the privilege of executing the commissioners' warrant in preference to the sheriff or any other person. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS No patient who is under charge or conviction of homicide may be discharged without order- of the board of control. Any patient who is cured must immediately be discharged by the Di ^ rge> superintendent and be furnished with suitable clothing and a sum of .money not exceeding $20, which shall be charged to the expenses of the patient in the hospital. The relatives of any patient not sus- ceptible of cure and not dangerous to be at large have the right to ^y rge to remove him with the consent of the board of control. On applica- I767 - tion of the relatives or immediate friends of any patient in the hos- pital who is not cured and who can not safely be allowed to go at liberty, the commissioners of insanity of the county where such patient belongs may authorize his discharge and provide for his care within the county. When a patient is discharged from the 1768 - NORTH DAKOTA 190 Penalties against counties. Charged against counties. 2568. 2569. Adjustments. 2571. 2576. Appeal. 2577. County may collect from estate of patient. 2579. hospital, without application, notice must at once be sent to the commissioners of insanity of the county where he belongs, who must have him removed and cared for in the county, as in other cases, unless the patient is discharged as cured. And if the com- missioners of insanity of such county neglect to remove such patient within thirty days from the date of the order of discharge, the county is liable to the state for the sum of $2 per day for the care and keeping of the patient at the hospital. The superintendent of the hospital must report annually all such delinquencies and the time of any patient kept beyond the period of thirty days to the governor. The amount thus reported is charged to each county named and made a part of the tax levied against the county. 7. COST OF MAINTENANCE The expense for the care, board, and treatment of all patients in the state hospital is a charge upon each county sending them. The superintendent must furnish the county auditor of each county having patients in the state hospital a quarterly statement giving the number of patients belonging to the county, the name of each patient, and the cost of his maintenance. When notified that a patient sent from one county has a legal residence in another, the superintendent must hold and keep him at the expense of the latter county, including expense already in- curred and unadjusted. Expense incurred by one county on account of insane persons whose legal residence is in another county must be refunded by the county of residence. When the county commissioners of a county make claim that a patient is not a proper charge against their county, and so notify the state auditor, stating that he is a charge against some other county, or against the state at large, the state auditor must notify the county auditors of each of the counties in question to file proofs within thirty days, and after investigation of the residence of the patient determines the matter. The superintendent of the hospital must thereafter treat the patient as from the county determined by the state auditor, and if he finds that the patient is not a proper charge against any county in the state, he must be regarded as a charge against the state at large. Any county may appeal from the determination of the state auditor to the district court of the county. The expense incurred by any county for the maintenance of a patient at the state hospital is a charge against his estate; provided, that he has no heirs within the United States dependent on the estate for support; and provided, that no real property may be sold during the life of the insane person nor any personal property under 191 NORTH DAKOTA five years from the date of sending the patient to the hospital, unless by order of the proper court when the property is liable to deteriorate in value. When it is sold, the county court must order the proceeds to be safely invested for the benefit of the insane person. The board of control fixes the amount to be paid for the care and J^tiSnt treatment of patients. The sum may not exceed twenty-four dollars Laws of I l8 - a month for residents of the state. Non-residents are required to pay the actual cost. 8. CRIMINAL INSANE If a jury finds that the defendant in a criminal case is insane, the ^-^ ns under trial or judgment must be suspende.d until he becomes sane, and Co pg| d taws - the court must, in the meantime, order him committed to the state hospital for the insane by the sheriff and re-delivered to the sheriff upon becoming sane, to stand trial or judgment or be discharged. When a jury returns a verdict acquitting a defendant upon grounds of insanity, the court may, if the defendant is in custody cri - and it deems his discharge dangerous to the public safety, order him to be committed to the state hospital for the insane or to the care of such person or persons as the court may direct, until he becomes sane. When any person, becomes insane during confinement, in the ^jJUJ^g penitentiary or reform school, the governor must make inquiry, and II2 !> 6 - if he determines that the person is insane, he must order him con- fined and treated in the state hospital for the insane, and upon his recovery, if before the expiration of the term for which he is com- mitted, returned to the penal institution from which he was taken. The superintendent of the hospital must notify the warden or superintendent of the recovery of a person transferred as provided, and the warden or superintendent must, if the term of sentence of the person has not expired, return him to the proper custody. If the term of imprisonment has expired at the time of recovery, the warden or superintendent may direct that he be released from further custody by the superintendent of the hospital. 192 Board of charities. P. &A. 1349- 1353- 1354- 1815-3. 1358. ommittee si tors. 1828. 1829. OHIO Authorities: Page and Adams Annotated Code of Ohio, 1912 Supplements, 1913-15 Laws of Ohio, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of state charities is composed of seven members, six of whom are appointed by the governor for terms of three years. The governor is ex-officio a member of the board. No more than three of the appointed members may belong to the same political party. The board must investigate the condition and management of all public benevolent and correctional institu- tions, both state and local. Officers in charge of such institutions must furnish the board the information it requires. The board may prescribe forms of reports and of registration. All plans for new state, county and city institutions must be submitted to the board for its approval. The governor may order the board to investigate the management of any institution. The board has an agent whose duty it is to investigate the financial condition of the inmates of the institutions and of the relatives liable for their support and is given special powers to that end. The board has authority to take deposi- tions, administer oaths and punish for contempt. The board must make a biennial report to the governor. The governor appoints annually a committee consisting of six women to visit the benevolent and correctional institutions of the state. The committee must visit the institutions at least twice a year and make a complete report of their observations and conclu- sions to the board of state charities. All the state charitable, correctional and penal institutions (includ- ing the state hospitals for the insane) are managed and governed by the board of administration. The board is composed of four members, not more than two of whom may belong to the same politi- cal party, appointed by the governor for terms of four years, and subject to removal by him for cause. Failure on the part of a member to attend three consecutive meetings of the board unless excused by formal vote may be treated by the governor as his resignation. The members must be selected with regard to their knowledge or experience concerning methods of care and treatment at the institutions and of business management. Each member receives a salary of $4,000 per annum and must devote all his time to the duties of his position. The board appoints a fiscal supervisor- 193 OHIO secretary, who receives a salary of $3,600 a year, and such other employees as may be necessary, and fixes their compensation. The board has all power and authority necessary for the exercise of l8 4 x - the executive, administrative and fiscal supervision of all state institutions and succeeds in all respects the former boards of trustees and boards of managers; it regulates the admission and discharge of inmates, as provided by law, including nonresident patients; it divides the state into hospital districts for the purpose of regulat- ing the admission of insane patients and fixes the quota to which each county is entitled. The board acts as a commission of lunacy with power to ex- I8 4i-s. amine into, with or without expert assistance, the question of the sanity or condition of any person committed to or confined in any public or private hospital, or restrained of his liberty by rea- son of alleged insanity at any place within the state, to order and compel the discharge of any such person who shall not be insane, and to direct what disposition shall be made of him. The board keeps in its offices a complete set of books and ac- l8 - counts with each institution, showing the nature and amount of every expenditure and an account of all appropriations. Super- intendents make requisition on the board for all supplies, which are purchased by competitive bidding. A record is also kept of l86 - each patient committed to the institutions. A member of the l861 - board must visit each hospital at least once a month and report to the next meeting of the board. In making necessary investigations, l868 - the board is given the powers of a justice of the peace to adminis- ter oaths, etc. The board is required to make an annual report in l86 s- detail to the governor. b. Institutional. Each state institution is under the executive Supenntend- control of a superintendent, appointed by the board of adminis- l8 5- tration, subject to the rules and regulations of the state civil service commission. The superintendent, with the approval x>f the board, selects the employees. The board fixes all salaries. The board must make rules and regulations to insure a strictly l8?I - non-partisan management and any member of the board, officer or employee of any institution, may be removed for exercising political influence and for seeking the employment or promotion of any person at any institution. The Longview Hospital (a county institution, although under state 30 4- supervision and receiving a state appropriation for maintenance) is under a board of five directors all of whom must be residents of 30 5. Hamilton county. Two are appointed by the governor, one by the judges of the court of common pleas, one by the judge of the probate court, and one by the commissioners of Hamilton county. Each 14 OHIO 194 of the directors holds office for five years. The powers and duties of the board are similar to those of the state board of administration so far as the general government of this institution is concerned. 2. CARE a. In state institutions. Columbus State Hospital, Columbus; established 1835; 1,820 beds. Cleveland State Hospital, Cleveland; established 1855; 1,775 beds. Dayton State Hospital, Dayton; established 1855; 1,279 beds. Athens State Hospital, Athens; established 1864; 1,400 beds. Toledo State Hospital, Toledo; established 1883; 1,810 beds. Massillon State Hospital, Massillon; established 1892; 1,763 beds. Lima State Hospital for the Criminal Insane, Lima; established 1906; 1,200 beds. 4. b. In local institutions. The Longview Hospital, Cincinnati, (established 1821; 1,521 beds) is maintained by the state for the exclusive benefit of residents of Hamilton county; the buildings and grounds are owned by the county. Very few insane are main- tained at the almshouses or infirmaries. The Cincinnati general hospital has a psycohpathic department. Detention Qn the request of the probate judge the county commissioners 3154. of the county may establish a detention hospital for alleged insane persons in proximity to the probate court, under charge of a reg- istered physician as superintendent, to be appointed by the pro- bate judge. Other necessary assistants are appointed by the superintendent. In counties where a municipality owns a hos- pital, the county commissioners may contract with it for the tem- porary care of alleged insane persons. 3. COMMITMENT E * P ersons committed. All insane persons, not feeble-minded or epileptics, who are residents of the state may be admitted to the state hospitals provided their insanity occurred during their residence in the l8 '7. state. Non-residents may be received when authorized by the board of administration, if the legal residence of the person can not be ascer- tained or other peculiar circumstances afford a sufficient reason. l8l - If it is found that the person whose commitment is requested has not a legal residence or the residence is in doubt, and the judge of probate believes that the person should be committed to a hospital, he must notify the board of administration to investigate the matter. tients' The mecu 'cal superintendent of each state hospital must inform 1 9* 1 - the probate judge of the different counties of the hospital district of the quota of patients to which the county is entitled and the number in the hospital therefrom. The probate judge may at any time commit an acute case if the quota is not full. 195 OHIO b. Legal procedure in commitment. A resident citizen of the^avit. proper county must file with the probate judge of the county an affidavit in prescribed form alleging the insanity of the person and that he is dangerous to the community if allowed at large and stating his legal settlement. Within five days after the affidavit is filed, ^54. the probate judge must issue a warrant for the apprehension of the alleged insane person, fix a day for the hearing, and summon wit- nesses, two of whom must be reputable physicians of at least five years' practice. If any person resists the affidavit, the judge must subpoena the Examination, persons demanded on behalf of the person alleged to be insane. The probate judge may examine the person out of court if it is deemed inadvisable to bring him into the court, and the proceedings re- quired may then be held in his absence. After hearing all the *9S*> testimony and being satisfied that the person is insane, the judge must cause a certificate to be made by two medical witnesses of the person's insanity. The medical witnesses must have at least five years' experience in the practice of medicine and not be related by blood or marriage to the person alleged to be insane or to the person making the application. The medical certificate must be in the Me( ? ical form prescribed by the state board of administration with the advice of the superintendents of the several hospitals. Upon receiving the 'oss. medical certificate, the probate judge must at once apply to the laws of *9i7. superintendent of the hospital situated in the district in which the patient resides, transmitting at the same time all the papers in the case together with a certificate that the person is free from in- fectious disease. The superintendent must immediately state whether the patient can be admitted. The proceedings for com- mitment to the Longview hospital of Hamilton county are of the same character. The relatives of a person charged with insanity, or found to be 1 o (Jx - insane, may, with the court's approval, take charge of him if they desire to do so. In such a case, the probate judge before whom the inquest has been held must deliver the insane person to them. When a person is discharged from a hospital as cured and again ws. becomes insane, the same proceedings must be had as in the case of the original application before he can be again admitted to a hospital for the insane. c. Voluntary admission. A person in an incipient state of w*- mental derangement may apply for admission to the state hospital in the district in which he resides. The superintendent of hospital may receive the applicant for not more than sixty days if, upon his own examination and the statement of a reputable physician familiar with his condition, he is satisfied that the applicant is in OHIO 196 1973. need of hospital treatment and will be benefited by it. The appli- cant must be an inhabitant of the state and must sign an application W4- in the form prescribed by the superintendent. No hospital may care for more than five voluntary patients at one time, nor may voluntary patients be admitted when the quota for the county is full. Habeas corpus, d. Appeal from commitment. All persons confined as insane are entitled to the benefit of the writ of habeas corpus, and the question of insanity must be decided at the hearing. If the judge finds the person insane, the decision is no bar to the issuing of the writ a sec- ond time if it is alleged that the person has been restored to reason. > a un bythe e> ^ ost * comim ' tment ' All expenses connected with inquests 1981'. of insanity, making records, conveying' patients, etc., are a charge upon the county from which the patient was committed. 4. CONVEYING PATIENTS TO THE HOSPITAL sheriff conveys, it is the duty of the sheriff to convey patients to the hospitals upon the order of the probate judge. If the insane person is a female, a suitable female assistant must be appointed to accompany the sheriff and the insane person to the hospital. 5. TRANSFER OF PATIENTS B dm?nis b raaon >f ^ & hospital cai * n <>t accommodate the patients of the district '952. to which it is attached, or if the interests of a patient make a transfer advisable, the board of administration may, with the consent of the superintendents interested, order the transfer of patients to the hospital of either of the other districts which at the time has room for such patients. Transfers made at the request of relatives or friends are at their expense, but all other transfers are at the expense of the hospital from which made. Requests. Upon the request of the probate judge of any county, the board of administration may authorize the commitment of an insane person to a hospital located in another hospital district, if the reasons set forth in the application warrant such action. 6. PAROLE AND DISCHARGE OF PATIENTS Paroles. When the superintendent deems it for the best interest of a patient who has no homicidal or suicidal propensities, he may permit him to leave the institution on a trial visit for not more than 90 days. The patient may be returned at any time within this period without further legal proceedings. Charges. With the consent and advice of the board of administration, the superintendent may discharge any patient from the state hospital when he deems it proper and necessary, except patients of homicidal . 197 OHIO or suicidal tendencies. If the condition of the patient justifies it, he may be permitted to leave the institution unattended. In case the patient requires an escort, the superintendent notify the probate court of the county of which the patient is an inhabitant, who must issue a warrant to a suitable person, giving the friends of patients the preference, for the removal of the patient to his home. When a patient is discharged as cured, the superintendent must ; furnish him with suitable clothing and a sufficient sum of money, not exceeding $20 for traveling expenses. If the friends of a patient ask his discharge, the hospital superin- tendent may require a bond, conditioned for the safe-keeping of the patient. No patient charged with or convicted of homicide may be discharged without the consent of the superintendent and board of administration. 7. COST OF MAINTENANCE The probate judge committing any person to a hospital for the ^ e * f ^ insane must certify to the superintendent the name and address of I8l 5- x ' 2 the guardian if any is appointed and of relatives who are liable for the person's support. The maximum rate for the support of in- mates is $3.50 a week. A husband is liable for the support of a wife, a wife for a husband, l8l s-9- parents for their children and children for their parents. Superintendents of hospitals must submit to the board of state ***$?* charities the information they may obtain in regard to the financial condition of any inmate or of relatives liable for his support. If the estate of any inmate is sufficient for his support without Guwdians. hardship to any dependents, and no guardian has been appointed, the agent of the board of state charities must petition the probate court to appoint a guardian. In cases of failure of relatives or guardian to pay for the sup- JjjJf^JSSu port of patients, the institution may pay such expenses and cer- I8l6> tify the account for collection to the auditor of the county from which the patient came. 8. CRIMINAL INSANE To the hospital for the dangerous and criminal insane are com- mitted: persons who became insane while in the state reformatory or the penitentiary; dangerous insane persons in other state hospi- tals; persons accused of crime but not indicted because of insanity; persons indicted but found to be insane; persons acquitted because of insanity; persons adjudged to be insane who were previously convicted of crime. OHIO 198 certificates Of i99s ence ' '996. 1998. When in an inquest of lunacy a prolate judge finds a person insane who has previously been convicted of arson, assault, rape, robbery, burglary, homicide or attempt to commit such acts, he must commit him to the Lima state hospital (for the dangerous and criminal insane). When the physician of the penitentiary or reformatory reports in writing to the warden that a convict is insane, the warden must apply to the probate court of the county in which the institution is located for an examination of the convict by two physicians of at least three years' practice in the state who are not 'connected with the peni- tentiary or reformatory. If satisfied that the convict is insane, the physicians must certify this in the form and manner provided for the commitment of insane persons to state hospitals. Convicts thus adjudged insane must be transferred to the Lima state hospital. An insane convict under indeterminate sentence, who is transferred to the Lima state hospital, must be detained for the maximum term of sentence provided by law for the offense for which he is convicted, unless sooner restored to reason. When restored to reason, and the superintendent of the hospital so certifies, a convict whose term of sentence has not expired must be transferred to the penitentiary or reformatory from which he came. ^ ^ ne msar] ity of a convict in a hospital continues at the expira- ^ on ^ his sentence, the superintendent must apply to the probate judge of the county within five days after the expiration of the sentence for an order to retain the convict until he is restored to reason and notify friends or relatives of the application. The pro- bate judge must notify the alleged insane person and call two physi- cians not related by blood or marriage to him, who have been in actual practice of their profession for at least three years. If the judge finds satisfactory proof of insanity has been adduced, he must order the retention of the convict until restored to soundness of mind. The form of commitment is substantially that required for the commitment of inmates to other hospitals. The superintendent may discharge patients not under sentence for crime who are recovered, or who are not recovered but whose condi- tion is so far improved that, their discharge, will not be detrimental to the public welfare or to themselves. 199 OKLAHOMA Authorities: Constitution of Oklahoma Revised Laws of Oklahoma, 1910 Supplement of 1915 Laws of 1917 i. ADMINISTRATION AND SUPERVISION a. General. A commissioner of charities and corrections is of elected in the same manner and for the same term as the governor, constitution. This officer may be of either sex, must be at least 25 years of age, H" and in all other respects have the qualifications required of the governor. His salary is $2,500. He must investigate the condi- tion and management of all charitable and correctional institutions supported wholly or in part by the state or by any county or munic- ipality. The officers of such institutions are obliged to furnish all information demanded by the commissioner. The commissioner - reports annually to the governor and the legislature. A state lunacy commission, consisting of the state commissioner ^^onf m " of health, the chairman of the state board of public affairs, and the Supplement of superintendents of the three state hospitals, is charged with the 7 4 b - general supervision of the policy to be pursued by each hospital and with the formulation and adoption of a permanent plan and system for proper care and treatment of the insane. The state hospitals for the insane are under the management of affairs f pubUc the state board of public affairs, consisting of three members, not 8 79 - more than two of whom may belong to the same political party, appointed by the governor with the consent of the senate for a period coterminous with his term of office. ; The board has the general direction of the affairs of the hospitals, ^^74! I917> appoints. the medical superintendents, assistants and physicians, and establishes by-laws, rules and regulations for the institutions. The board must meet at the different hospitals at least twice each year, and at such other times as are prescribed by the "by-laws. The superintendents and the state commissioner of health must meet with the board. A committee must visit and inspect each institu- tion once every three months and the entire board must visit and inspect the institutions at least once a year. Biennial reports of the results of the inspections must be made to the governor. They must be accompanied by the reports of the superintendents. The county commissioners have supervision of the insane are committed or admitted to the county poorhouses and jails. OKLAHOMA 200 Superintendent, 5 5 s III o o b. Institutional. The superintendent is the chief executive officer of each institution. He must be a legally registered physician, experienced in the care of the insane. He appoints his assistants and attendants, with the approval of the board of public affairs, and may suspend officers until the next meeting of the board. He must personally examine each patient after admission, and visit all wards. 2. CARE a. In state institutions. Central Oklahoma Hospital for the Insane, Norman; established, 1895; beds, 1,000. Western Oklahoma State Hospital for the Insane, Supply; estab- lished, 1902; beds, 700. Eastern Oklahoma Hospital for the Insane, Vinita; established, 1913; beds, 650. b. In local institutions. Insane persons who can not be received at the state hospitals or who for other reasons are not sent there, may be cared for in county poorhouses or jails, under the supervision of the county commissioners. 3. COMMITMENT a. Persons committed. Patients are divided into three classes, public, private, and voluntary. No person who is a resident of the state may be held as a patient in any hospital except upon a certif- icate of insanity and an order of admission. Nonresidents may be admitted at private patients. The board of public affairs, the medical superintendents, and the state commissioner of health may divide the state into districts. Patients may be sent to the hospital of the district in which they reside. b. Legal procedure in commitment. Patients are not admitted except upon certificates of insanity and orders of admission. The certificates must be made by two reputable, registered, graduate physicians. Application for an order of admission may be made to the county court or the judge by the father, mother, husband, wife, brother, sister, or child of the person alleged to be insane, or by the sheriff, superintendent of the poor, supervisor of any township or any peace officer. The court must fix a day for the hearing and appoint two reputa- ble physicians to examine the person. Notice must be served personally upon the person and the relatives or persons with whom he resides at least twenty-four hours before the hearing. Personal service may be dispensed with upon the order of the court, in which 201 OKLAHOMA case a guardian ad litem is appointed by the court. . If a jury is not !* demanded, the court may determine the sanity or insanity of the person. If demanded or if deemed necessary, a jury of six free- holders must be summoned by the court. If found to be insane, the court must issue an order for admission Commitment. as a public or a private patient. No person may be admitted under any order after the expiration of thirty days from its date. Notice of the order of admission of a public patient must be given by the judge to the prosecuting attorney. If two qualified physicians certify that it is necessary, patients JltSK 7 may be temporarily detained in the hospital, pending commitment, for not over thirty days, unless the time is extended by the court. When patients can not at once be admitted to a state hospital ^mhospitai and can not with safety be allowed to go at liberty, the county com- missioners must require them to be suitably provided for otherwise R^se until admission can be had, or until the occasion therefor no longer 4566> exists. Such patients are considered as private patients when relatives or friends obligate themselves to take care and provide for them without public charge. In this case the commissioners must appoint some suitable person a special custodian, with author- ity and the duty to restrain, protect and care for the patient. In the case of public patients, the commissioners must require them to be restrained, protected and cared for by the commissioners of the county or overseers of the poor, at the expense of the county. If there is no poorhouse for their reception, of if no more suitable place can be found, they may be confined in the county jail in charge of the sheriff. Or the commissioners may require that such patients be taken to a hospital in any state designated by the gov- ernor, who is authorized and empowered to make the best terms he can with the authorities of any state for the admission of such patients. On application to the county commissioners, on behalf of persons alleged to be insane and whose admission to a state hospital is not sought, asking that provision be made for their care as insane, either public or private, within the county and on proof of their insanity and need of care, the commissioners may provide for them as in the case of other applications. On information that an insane person in the county is suffering for want of proper care, the commissioners must at once inquire into the matter and make all needful provision for his care. c. Voluntary admission. After providing ample accommodations ^m! I9I7> for all public and private patients entitled to admission, the super- I3> intendent may receive and detain as a boarder and patient any resident of the state who applies for admission, if his mental con- OKLAHOMA 202 dition is such as to render him competent to apply for admission, provided the approval of the judge of the county in which the person resides is obtained. A voluntary patient may not be de- tained for more than three days after having given notice in writing of his intention or desire to leave. Persons afflicted with serious nervous disorders who are not insane may be admitted in a similar manner, if in addition a certificate of two reputable physicians is presented. **' A PP eal f rom commitment. On a statement verified by affida- vit addressed to the county judge of the county in which the hospital is situated, or of the county in which a person confined in the hos- pital has his legal settlement, alleging that he is not insane, the judge must appoint a commission of not more than three persons to inquire into the case, one of whom must be a physician, and if two or more are appointed, one must be an attorney. They must have an interview with the person alleged not to be insane and report to the county judge. Their report must be accompanied by a state- ment of the case and be signed by the superintendent. If the county judge finds the person not insane, he must order his discharge; if not, he must authorize his continued detention. The commission may not be repeated oftener than once in six months for the same patient, nor may a commission be appointed in the case of any patient within six months of the time of his admission. e. Cost of commitment. The expenses attending the commit- ment of an insane person, including the compensation to officials, are paid out of the county treasury, but the allowance to the sheriff and his expenses are a charge upon the state treasury. 4. CONVEYING PATIENTS TO THE HOSPITAL The sheriff of the county may execute the warrant of the court directing the transportation of a patient to the hospital, or the court or judge may appoint some other suitable person to execute it. No female patient may be taken to the hospital without the attendance of some other female, or some relative. If any relative or intimate friend of the patient, who is suitable, requests it, he Jias the privi- lege of executing the warrant, in preference to the sheriff .or any other person. 5. TRANSFER OF PATIENTS L!WS of?!S, The superintendent of any state eleemosynary institution may ch ii. 74 ' certify to the county court the name of any inmate who is in his opinion insane. The court must cause the inmate to be examined by two reputable physicians and hear witnesses. If adjudged insane, the court may issue an order for the commitment of the ch. W i S 74 f . I9I7> 203 OKLAHOMA inmate as a public patient. Upon restoration, the inmate must be returned to the institution from which he was transferred. Patients may be transferred to the state hospital upon the order g y v eraor. of the governor, after certification by the board of public affairs. 23- Expenses of all transfers are paid out of the general fund, upon Expenses * the certification by the board of public affairs. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent may discharge recovered* patients. Those Di ^ harge> who are not recovered may be discharged if a notice is sent to the friends of the patient or to the proper county officer; if the patient is not removed within ten days, he must be returned to his home, friends, relatives or to the county officer. If the superintendent refuses to discharge a patient upon request, the matter is determined by the court. A discharged patient may be readmitted under the original order within six months, but thereafter, he may be read- mitted only upon a new adjudication of insanity and a new order of admission. No patient may be discharged without suitable clothing. Upon J t -^ nd the order of the superintendent, clothing and money not exceeding twenty-five dollars must be furnished to each discharged patient. All persons confined as insane are entitled to the benefit of thefeviled < La^s S .' writ of habeas corpus, and the question of insanity must be decided 457S at a hearing. The medical history from the books of the hospital must be given in evidence and the superintendent or officer in charge of the institution may testify as to the mental condition of the person. If the judge or court decides that the person is insane, this decision is no bar to the issuance of the writ a second time, whenever it is alleged that he has been restored to reason. The superintendent may grant a parole to a private patient not Lawsof 1917, exceeding thirty days at any one time. The parole does not affect ch ig. 74 ' the validity of the charge for the support of the patient. 7. COST OF MAINTENANCE If a bond for support is given at the time of admission, the patient J^Ss. is admitted as a private patient. If the bond is not supplied at the ^.^74! I$>17 ' time of admission, the patient is admitted as a public patient but " the county is liable for the support of the patient for one year. If no bond is then supplied the patient becomes a public patient. The state pays the expenses of maintaining all public patients. The estate or relatives of any public patient are liable to the state for all expenses incurred. The county attorney represents the state in all proceedings to reimburse it for expense of maintaining public patients. OKLAHOMA 204 Relatives liable. Relatives who are able may be ordered to pay reasonable sums not exceeding two hundred dollars a year for the support of inmates. Orders for payment may be vacated by the court. Private patients may be declared public patients and public patients may be declared private patients upon the order of the court. The rate of charge per week to be paid for the treatment of all patients is fixed annually by the joint boards, and may not exceed the actual cost, including officers' salaries. Extra attendance may be furnished by special contract. The rate of charge for voluntary patients is the same as for public and private patients. Indigent voluntary patients may be sup- ported by the state upon approval by the board of public affairs. 8. CRIMINAL INSANE R< 6oso d Laws ' If doubt arises as to the sanity of the defendant in a criminal |p; procedure, a jury must be summoned to try the question. If found insane, the defendant is committed to the care of the sheriff until he becomes sane. The expense is paid by the county but may be collected from the estate of the defendant or from a relative. Insane convicts must be cared for in the hospital and returned to the penitentiary upon recovery, unless their terms of sentence have expired. Rate of charge. 33. Voluntary patients. 13- 25- Insane convicts. 7037. 205 OREGON Authorities: Lord's Oregon Laws, 1910 Laws of 1913, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control, consisting of the gov- ernor, secretary of state, and state treasurer, has general power direction and supervision over all state institutions including the hospitals for the insane. It makes by-laws, suspends or discharges executives and subordinates, fixes such salaries as are not fixed by law, prescribes duties for executive heads where they are not pre- scribed by law and additional duties deemed for the good of the public service. Meetings of the board are open to the public and their records always open to inspection. The board must visit the state hospital at Salem every three months and the hospital at Pendleton once a year and report Menially to the legislature. The report must be mailed to each member of the incoming assembly at least thirty days before it convenes. The board appoints a salaried secretary who visits the institutions at stated intervals or when directed by the board and among other duties serves as purchasing agent. b. Institutional. There are no local boards of trustees. The board appoints a superintendent for each hospital (salary per annum). He appoints his assistants;' he prescribes treat- ment and discipline subject to the rules of the board. It is provided that the institution at Salem shall have three assistants, the institu- tion at Pendleton two, but the board may authorize the employment of other necessary physicians. The superintendent may also ap- point other officers and employees subject to the approval of the board. He may suspend or remove subordinates subject to the approval of the board. 2. CARE a. In state institutions. Oregon State Hospital, Salem; established 1883; 1,684 beds. Eastern Oregon State Hospital, Pendleton; established 1913; 600 beds. b. In local institutions. The indigent insane who can not be admitted to or kept at the state hospitals are under the supervision of the county courts, which have the exclusive superintendence of the poor in their respective counties, and which may provide for them in almshouses. OREGON 206 Application. 343. 3- Examination. Paid by the county. Attendant conveys. 6. 3. COMMITMENT a. Persons committed. All insane persons, residents of the state, are entitled to admission to a state hospital. b. Legal procedure in commitment. The county judge of any county in the state, upon application of any citizen in writing stating that any person by reason of insanity is suffering from neglect, or is unsafe to be at large, must cause such person to be brought before him for a hearing, summoning at the same time one or more competent physicians to examine the person alleged to be insane. If the physician or physicians, after careful examination, certify under oath that the person is insane, the judge upon approv- ing their findings, must provide for the safe-keeping of the person and cause him to be conveyed to a state hospital. When a person is adjudged insane, the county judge must make a warrant reciting his findings, the name, age, nativity, and present residence of the pa- tient, and a copy of the physicians' certificate. The warrant is recorded in the findings of the court and a copy sent with the pa- tient to the superintendent of the hospital and another to the secretary of state. c. Voluntary admission. .d. Appeal from commitment. An appeal lies from the county court in insanity cases and in the same manner as provided for appeals from the county court in other cases. e. Cost of commitment. The cost of examination and committal is to be paid by the county in which the examination was made; but the cost of transporting patients to the hospital is borne by the state. 4. CONVEYING PATIENTS TO THE HOSPITAL The person committed, together with the warrant of the judge and certificate of the physician, must be delivered to the sheriff of the county, and by him to the agent appointed by the superintend- ent to convey the insane person to the hospital. By the board. Laws of 1913. 78. 17. Laws of 1917, ch. 151. 5. TRANSFER OF PATIENTS The board may transfer patients from one hospital to the other in order to improve their condition or lessen their cost of mainte- nance. Transfers may be made, by the board, from the penal in- stitutions, if upon examination, the inmates are found to be insane. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent shall discharge such patients as are in his opinion properly fit to be discharged. 207 OREGON 7. COST OF MAINTENANCE Indigent insane are cared for at the hospital at the expense of the^ b y the state. 8. CRIMINAL INSANE A person acquitted of a criminal charge on the ground of insanity, if deemed by the court dangerous, must be committed to any insane crime hospital to remain until he becomes sane or ^s otherwise discharged by authority of law. When any convict confined in the state penitentiary is in the opinion of the warden or prison physician insane, notice must be given to the clerk of the board which then orders an examination by one or more of the physicians of the state hospital. If they report the convict insane the board must order him transferred to the state hospital for treatment; but the board may at any time cause him to be transferred back to the state penitentiary. 208 PENNSYLVANIA Board of public charities. Digest. Page 4753- 136. Committee on lunacy. 138. 137. 139. 140. 141 (i). Private institutions. 145. Authorities: Pepper and Lewis' Digest of the Laws of Pennsylvania, 1907 Laws of Pennsylvania, 1911, 1913, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The general supervision over all hospitals and in- stitutions for the care and treatment of the insane is entrusted to the board of public charities through its committee on lunacy. This 1 committee consists of five members who are appointed by the gov- ernor for terms of five years and one of them must be a member of the bar of at least ten years' standing, and one a practicing physician of at least ten years' standing. The committee on lunacy must ex- amine personally or through its secretary and report annually to the whole board the condition of the insane in the state, and the management of hospitals, public and private almshouses, and all other places where insane are cared for and treated. The committee, with the consent of the chief justice of the su- preme court and the attorney general, has authority to license all places in which insane persons are cared for, except prisons and state hospitals. It is a misdemeanor to conduct an institution for the insane without a license, or when a license has been suspended. The committee makes all regulations for the proper treatment of insane, for the commitment of the insane, and the forms to be observed in regard to the commitment and transfer of custody and- discharge of patients other than those committed by the order of a court of record. It furthermore regulates the number of persons that may be detained, the accommodations to be provided, and all other things pertaining to the management and control of institutions for the care or detention of the insane. The board and the com- mittee on lunacy make annual reports. For each county in which there is a hospital or place where insane persons are kept, a board of visitors, consisting of not less than three persons, must be appointed by the board of public charities. b. Institutional. The state hospitals are under the direction and control of boards of trustees or managers that vary somewhat in com- position, but generally consist of nine members, appointed by the governor for terms of three years. The boards have general control of the affairs of the hospitals and appoint the superintendents, who Laws 7 f 1913>m ust be skillful physicians and are subject to removal or re-election not oftener than once in three years, except for breach of trust. The The superintendents appoint and control all subordinate officers, subject to the approval of the trustees. 141 (7). Boards of visitors. 142. Boards of trustees. Pages 4710- 4738. Superintend- ents. 209 PENNSYLVANIA 2. CARE a. In state institutions. Pennsylvania State Lunatic Hospital, Harrisburg; established 1845; 1,000 beds. State Hospital for the Insane, Danville; established 1872; 1,450 beds. State Hospital for the Insane, Warren; established 1873; 1,282 beds. State Hospital for the Insane, Norristown; established 1879; 3,200 beds. State Asylum for the Chronic Insane of Pennsylvania, Wernersville; established 1891; 875 beds. Homeopathic State Hospital, Allentown; established 1901; 1,000 beds. State Hospital for the Criminal Insane, Waymart; established 1905; 150 beds. Western State Hospital for the Insane, Westmoreland County; au- thorized 1915. Eastern State Hospital for the Insane; authorized, 1917. b. In local institutions. Several counties and cities maintain their own institutions for the insane in connection with the county homes or as separate hospitals under the supervision of the directors of the poor of the county or the municipal authorities, as the case may be. The Philadelphia general hospital has a psychopathic ward of 175 beds. Hospitals maintaining medical and surgical staffs, and in which |^g pathic courses of lectures in mental diseases are open to medical students ^ S 55 f 1911 ' may, with the consent of the board of public charities, maintain ' psychopathic wards for the reception and treatment of persons suffering with mental disorders. Provision is made for the employment of the insane confined in o Sfa e ne. institutions, wholly or in part maintained by the state, and for the j|g S ^ 768 distribution of the supplies, manufactured articles, goods and prod- l83 - ucts made in any state institution for the care of the insane, feeble- minded and epileptic. The trustees of the insane or district overseers of the poor may^ porary provide a building, or a room in a building separate from the insane J;* W 6 S 5 of Ipl7 department of the district, for the care, treatment, and maintenance of persons committed to their care who are temporarily mentally deranged. 3. COMMITMENT a. Persons committed. All insane persons are entitled to ad- mission to the state hospitals for the insane or to county or city asylums where such are maintained. Pay patients may be re- ceived, but indigent insane shall have preference. b. Legal procedure in commitment. On statement in writing to oS aint ' a judge in the common pleas or quarter sessions of any respectable Page " 4 - PENNSYLVANIA 210 Investigation. Disposition. 129. Report to committee on lunacy. 134- Certificate of insanity. Page 474 1- 103. Laws of no. 59. Digest. P. 4741. 105. Procedure on admission. 108. person that a person is insane, and that the welfare of himself or of others requires his restraint, the court must immediately appoint a commission to inquire into the facts of the case. This commission must be composed of three persons, one of whom at least shall be a physician and another a lawyer. They hear evidence and the statements of the party complained of, or of his counsel, and if, in their opinion, it is a suitable case for confinement, the judge must issue his warrant for such disposition of the insane person as will secure the object of the measure. When a person is found by inquisition to be insane, the committee of the person or of the estate, and also the clerk of the court in which the inquisition has been returned, must send to the committee on lunacy a statement signed by the committee of the lunatic, giving his name, age, sex and residence. The committee on lunacy may visit and examine the lunatic and is authorized to apply to any court, having jurisdiction over the committee, or to a judge of a court of common pleas of the county in which the lunatic is a resident or detained, to make such orders for his maintenance and for the care and disposition of his property as the case may require. If it is made to appear to any law judge that an insane person is suffering from the want of proper care or treatment, he must order him placed in some hospital for the insane, at the expense of those who are legally bound to maintain him, but not such order may be made without due notice to the persons to be affected thereby, and the hearing had thereon. No person may be received as a patient in any institution for the insane without a certificate signed by at least two resident physicians who have been in actual practice for at least five years, both of whom must certify that they have examined separately the person alleged to be insane, and that he requires care and treatment in a hospital > or other establishment for the insane. The certificate, duly attested under oath, before a judge of the county certifying to the standing and good repute of the signers, must have been made within a week of the examination of the patient, and within two weeks of the time of the admission of the patient. No person alleged to be insane may be received into any house for treatment or detention unless at the time of his reception the person or persons at whose instance com- mitment is made states in writing that in their belief the detention is necessary and for the benefit of the insane person. The law prescribes in detail the facts concerning insane persons which must be made known at the time of admission to the superin- tendent who receives him. Within twenty-four hours after the reception of a person in any hospital, these facts must be entered in a book kept for that purpose. The regular medical attendant must 211 PENNSYLVANIA then examine the patient and reduce the results of the examination to writing. The medical attendants of hospitals are required to report to committee on lunacy, within seven days from the time of the tion of the patient, the statements given at the time of the reception of the patient, and the results of the examination. At least once in six months, a report must be made on the condition of every patient. The managers and officers of a hospital for the insane are not ^ riti h e spital liable to the penalties imposed by the law in case of receiving for n Jj* ble - detention an insane person without complying with the legal re- quirements, if the judge trying the cause certifies that the officers and managers had good reason to believe that the reception and detention were necessary for the safety of the insane person. But o^est n>s the person must be legally committed or discharged from custody p^eJ-Lewis within 48 hours, and the board of public charities must have been p'^j notified of the facts connected with the reception and detention. Persons suffering from mental disorders may be committed for not ^o^^ at more than thirty days to the psychopathic wards of hospitals for^ s ss f I9 " observation and treatment in the same manner as persons are com- 3> mitted to hospitals for the insane. The courts before whom persons charged with offenses are brought for examination or trial may in like manner commit them to psychopathic wards for observation and diagnosis. But persons admitted to these wards who are found insane must be regularly committed and removed to a hospital for the insane within thirty days. Whenever a person has become insane or so mentally defective of p ^ that he is unable to take care of his property, the immediate relatives, creditors, or in their absence, any other person, may present to the court of common pleas of the county in which the person resides a petition under oath, asking the court to adjudge such person to be unable to take care of his property and to appoint a guardian for the estate of such person. The hearing of the petition must be in the presence of the person against whom it is presented, unless it is unsafe to require his presence. If the court is satisfied that the person is not able, owing to insanity or weakness of mind, to take care of his property, he must enter a decree accordingly, and ap- point a guardian to take care of it. Upon written request, a trial of the case may be had by jury. When a decree has been issued, a guardian must be appointed with the same powers as the committee on lunacy. c. Voluntary admission. Persons who are threatened with mental disorders and voluntarily place themselves in institutions for the insane may be received for a period of one month or less by an agree- ment which must specify the time and be signed by them at the PENNSYLVANIA 212 Page 4749- 126. time of their admission. At the end of one month they may renew the agreement, but no agreement is valid unless signed in the presence of some adult person attending as a friend of the applicant, and by the medical attendant. Habeas corpus, d. Appeal from commitment. On a sworn statement addressed by some respectable person to any law judge, that a person confined in a hospital for the insane is not insane and unjustly deprived of his liberty, the judge must issue a writ of habeas corpus and hold a public hearing on the question. The onus of proving the person J 34- insane rests upon those restraining him of his liberty. From an order by a court regarding the care of an insane person and the dis- position of his estate, an appeal may be taken to the supreme court. e. Cost of commitment. If a person is found to be not suitable for commitment as insane and the proper court or a law judge so affirms, the one petitioning for his commitment is liable for all costs. If he is found suitable for commitment and has sufficient property, the property is liable to all costs. If the person is found insane and suitable for commitment and has not sufficient property, the county liable for his support in the hospital is also liable for all costs. 4. CONVEYING PATIENTS TO THE HOSPITAL When an indigent female insane patient is to be removed from one place or institution to another or returned from an institution, the court under whose order she is committed, or the commissioners of the county or the overseers of the poor of the district must pro- vide a female attendant for every female patient in transit, unless the patient is accompanied by a member of her family. Refusal to comply with this provision or neglect to do so is subject to a penalty of $250. 5. TRANSFER OF PATIENTS The committee on lunacy is authorized, when satisfied that any of the state hospitals for the insane are overcrowded, to transfer patients from one state hospital to another and the liability of the municipalities, poor district, or persons, for the support of the patient is continued. The cost is paid from the general appropria- tion for the insane. 6. PAROLE AND DISCHARGE OF PATIENTS In case the medical attendant of a hospital is of opinion that detention is not necessary for the benefit of the patient, he must notify those at whose instance the patient is detained, and unless satisfactory proof to the contrary is forthcoming within seven days, the patient must be discharged. All persons detained as insane other than the criminal insane must be discharged as soon as they are restored to reason and competent Page 4761. 1 66. Female at- tendant. 167. Laws of 1917, no. 133. Discharge by medical attendant. Digest. Page 4744- 109. On recovery. 114. 213 PENNSYLVANIA to act for themselves. The committee on lunacy must be notified of "s- all discharges within seven days after they have been made and may " 6 - at any time order the discharge of any person detained as insane other than* criminals, but not without due notice to the person in charge of the institution where the patient is kept and to the persons at whose expense the patient is detained. The committee may not sign an order of discharge unless they have personally attended and examined the case of the patient. On statement in writing to any law judge by some friend of a "^"/JJ! person placed in a hospital that he is losing his bodily health, and pavement, that his welfare would be promoted by his discharge, or that his mental disorder has so far changed its character as to render further confinement unnecessary, the judge must make suitable inquisition and may or may not order the discharge of the person. Persons placed in any hospital for the insane may be removed those who have become responsible for the payment of their ex- penses, provided, that such obligation was the result of their own free act, and that its terms require the removal of the patient in order to avoid further responsibility. Whenever any indigent insane inmate of a hospital is discharged, the authorities of the hospital must pay the traveling expenses of the j7 31 f 19I7> inmate to his home. 7. COST OF MAINTENANCE The expense of the care and treatment of the indigent insane the state . hospitals for the insane is fixed at two dollars and fifty Jj]^ 9> of 19I7 cents per week for each person. The amount includes the cost of no - 65) - clothing. It is charged to the counties or to the poor districts from which the person was committed. The excess, which may not exceed two dollars and fifty cents per week, is paid by the state. The cost of maintaining persons in the hospital for the chronic insane may not exceed four dollars per week. Two dollars of the amount must be paid by the counties or by the poor districts and the remainder by the state. Any county, subdivision thereof, or city maintaining a suitable UJJ^- institution for the insane is entitled to receive from the state the 1 *-^ 44 - sum of $2 per week for each indigent insane person committed to the institution or transferred to it from a state hospital. The county from which he was sent is liable for the support of an l6a< insane person who has been committed to it by any court. Hospitals maintaining psychopathic wards are entitled to receive k* 5 0( from the state $2 per day for each indigent person received during 3. the time of his stay. PENNSYLVANIA 214 When and where commit- ted. P. 4744- Digest. 122. Parole. Laws of 191 1, Page 273- i. 3- Discharge. Digest. P. 4744- 123. Persons liable. The husband, wife, father, mother, or child of a patient in any asylum or hospital maintained in whole or part by the state, if able to pay, is liable for the maintenance of the patient. The value of a patient's estate must 'be reported to the attorney general yearly in order that proper charges may be made against it. 8. CRIMINAL INSANE When a person is acquitted in a criminal suit on the ground of insanity, the court must order the prisoner to be committed to some place of confinement for safe-keeping or treatment. The person may, however, be released from custody on parole by the court in which he was acquitted. The court directing the release on parole on the grounds of insanity may prescribe such terms and conditions of release as to it may seem proper. If, after a confinement of three months' duration, any law judge is satisfied by the evidence presented to him that the prisoner has recovered, and that the paroxysm of insanity in which the criminal act was committed was the first and only one he had ever experienced, he may order his unconditional discharge. If it appears that the paroxysm of insanity was preceded by at least one other, the court may appoint a guardian of his person under bond for any damage his ward may commit. In case of homicide or attempted homicide, the prisoner may not be discharged, unless in the opinion of the superin- tendent and three-fourths of the managers of the hospital and the court before which he was tried he has recovered and is safe to be at large. Insane convicts may not be received at any hospital except when delivered by the sheriff on order of the court of the county in which they were arrested or committed, nor may such convicts be dis- charged from a hospital except upon an order to the sheriff or his deputy by the court. If any person detained in any prison is in- sane or in such condition as to require treatment in a hospital for insane, any law court under whose order the person is detained must upon application make an inquiry into the circumstances, either by a commission or otherwise, with notice to the committee on lunacy, and if the judge is satisfied that the person requires hospital treat- ment, he must direct his removal to a state hospital, the cost to be borne by the county liable for his maintenance in prison. The discharge of an insane convict confined in any hospital by order of any court or of a person who has been acquitted on trial because of insanity and likewise confined, is prohibited except by order of a court of competent jurisdiction; and in such a case, the insane person, whether a convict or acquitted, is not to be set at large, but to be removed to a place of custody other than a hospital. Commitment of insane convicts. 112. Discharge of insane con- victs. 113. 215 PENNSYLVANIA The order for removal may not be made without notice to the com- mittee on lunacy, and time must be given them to investigate the case and act on the application. Whenever any person committed to jail charged with an off ense ! n * f in i '17' not amounting to a felony is found to be insane, he may be re- no - 265 - moved to a hospital for the insane. The cost of commitment, removal, and maintenance of any person cost of main- committed to a state hospital as an insane criminal must be paid by La?of 1917. the county wherein the crime was committed. The county may recover the amount expended or any part thereof from the estate of the person or relatives liable for his support, but not from the poor districts. 216 Penal and charitable commission. Laws of 1917. 1470. 1,2. 3, 19. General lavrs. ch.96. 46. Boardinr Datients. Laws of 1914. General laws, ch. 96. ii. Application. 48. RHODE ISLAND Authorities: General Laws of Rhode Island, 1909 Public Laws of Rhode Island, 1909-1910, 1912, 1914, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The penal and charitable commission consists of nine persons. Three of the members are appointed from the county of Providence, one from each of the other counties and two from the state at large. They are appointed for terms of six years and serve without compensation, but receive their traveling expenses. The governor may remove or suspend any member. The commission has full management and control of the state penal and charitable institutions, including the hospital for mental diseases. Meetings must be held at least once every month and at such other times as may be determined. Annual reports must be made to the assembly. The commission appoints the officers for the institutions and determines their salaries. b. Institutional. There are no local boards of trustees. 2. CARE a. In state institutions. State Hospital for Mental Diseases, Howard; established 1869; 1,400 beds. The state also contributes to the support of patients in the Butler hospital, Providence, which is an incorporated institution under private management. b. In local institutions. Insane persons may be provided for in town asylums, but not unless, in the opinion of the secretary of the penal and charitable commission, they are properly cared for. e. In families. The penal and charitable commission may place any chronic, quiet patient in board with any suitable family at a cost not exceeding maintenance in the state hospital. 3. COMMITMENT a. Persons committed. All insane persons who are residents of the state are entitled to be cared for at the state hospital or may be supported in part at the Butler hospital by the state. Parents, guardians, relatives or friends may place insane persons in a hospital for the insane provided they present to the superintend- ent a certificate of insanity from two physicians of good standing. The state is not liable for the support of such patients. b. Legal procedure in commitment. Upon the written applica- tion of the parent, guardian, relative or friend of an insane person, 217 RHODE ISLAND accompanied by the certificates of two practicing physicians regis- tered in the state, that such person is insane, the penal and chari- table commission is authorized to receive him for care and treatment upon such terms as it may fix. Upon sworn complaint to any justice or clerk of a district court ^ r f aint that a person within the county is so insane as to be dangerous to the peace and safety of the public, the justice or clerk must issue a warrant for the person and have him brought before the district court for examination. When the complaint is accompanied by a certificate signed by two practicing physicians in the state declaring that the alleged insane person can not without serious consequences be examined in open court, district courts are empowered to hold examinations at times and places most conducive to the health and comfort of the person examined. When an examination is made at any other place than in open court, the justice may not commit the person to a hospital without having the testimony of two practic- ing physicians of good standing that the person is insane and in need of restraint. If the court holds the complaint to be true it must, 2 - unless some other provision for the adequate restraint and treatment of the person satisfactory to the court is made, commit him to the Butler hospital or to the state hospital for mental diseases. On a sworn petition setting forth that any person is insane, and commissioners, should be placed in the hospital for mental diseases, any justice of the supreme court may call in not less than three commissioners to make inquiry and report whether the person in question is insane or not; and if insane, he must be placed in a hospital, either for cure or for restraint. The commissioners must give notice to the person Notice - complained of as insane of the time and place of hearing, so that by his own statements or by counsel he may defend himself. The commissioners may issue summons and compel the attendance of witnesses. When the person alleged to be insane is unable to obtain counsel and summon witnesses, the court or commission must ap- point a competent counsel and summon all necessary witnesses. The justice may issue a warrant for the apprehension of the person w | rrant - complained of and order him detained by the officer to whom the warrant is directed or to be committed to the Butler hospital or the state hospital for mental diseases, or other public place for detention, pending the inquisition. Upon the report of the commissioners the - justice may, without further hearing, order the person complained of to be confined in the Butler hospital or the state hospital, or in some other curative hospital for the insane, or he may dismiss the petition. Insane persons may be placed in the Butler hospital or " other curative hospital for the insane, supervised by officers ap- pointed under the authority of the state, by their parents or guard- RHODE ISLAND 218 ians, or by their relatives or friends, but the superintendent of the hospital may not admit any person without a certificate from two practicing physicians of good standing, stating that the person is insane. 4J - Any physician who unlawfully commits to any hospital for the insane a person who is not insane is liable to a fine not exceeding $500 or imprisonment not exceeding five days. c ' Voluntary admission. The superintendent of any hospital for the insane may receive as a boarder and patient any person who is desirous of submitting himself to treatment, and who makes a written application, but whose mental condition is not such as to render it legal to grant him a certificate of insanity. Such a boarder may not be detained for more than three days after having given notice to the superintendent of the hospital that he desires to leave it. <* A PP eal fr m commitment. On petition of any person con- insan I e fined ^ ne( ^ m an institution for the insane, or of any person on his behalf, j s- to a justice of the supreme court, stating that he has reason to be- lieve that such person is not insane, the justice must issue a com- mission for the purpose of inquiring into the condition of the person. The personal examination by the commissioners of the person de- tained as insane must take place in the institution where he is de- l8 - tained, except by order of the justice issuing the commission. In other respects the commission has the same power, and proceeds in the same manner as provided in case of examination for the com- ** mitment of the insane. The right of any person to the writ of Habeas corpus, habeas corpus is not abridged; and upon application for it, the court must inquire into and determine the sanity or insanity, or the neces- sity for restraint, of the person confined. If it appears necessary to the court, the case must be submitted to a jury in the superior court. comiL ? s f sion, ^ commission may be issued until the applicant pays or secures h he was committed. The estate of any such insane person is liable for the maintenance. On petition of the penal and charitable commission, stating that any convict in the state prison or in the Providence county jail, or on the petition of the clerk of the superior court for any of the other counties, that a convicted prisoner in the jail of his county is insane, idiotic, or permanently incapacitated for mental or physical labor, the presiding justice of the superior court, or in his absence any justice of the superior court, may order his examination, and 221 RHODE ISLAND transfer him to the prison insane ward, the state hospital for mental 3 - diseases, or the state infirmary. The order must be for and during General Laws, the term of the prisoner's sentence. ch^p6. Upon restoration to reason or to health, any person thus trans- ferred may, by order of the presiding justice of the superior court transferred to the place of his original confinement, to serve out the 1 remainder of his sentence. 222 SOUTH CAROLINA Board of charities and corrections. Acts of 1915. 100. Board of regents. Acts of 1917, No. 121. Code. 3355. Superintendent. Acts of 1915. 100. Acts of 1917, No. 121. Code. 3356. Authorities: Code of Laws of South Carolina, 1912 Acts of 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of charities and corrections has visitorial and advisory duties without administrative or executive powers. It consists of five members appointed for the term of five years. The board or its secretary inspects the hospitals for the insane at least once in six months. The board inspects the workings and results of chartered institutions or associations engaged in the care of defective children or adults and makes reports therein. It appoints in each county or city a local committee of three visitors. b. Institutional. The state hospital for the insane is under the direction and control of a board of regents, consisting of five members appointed by the governor for terms of six years. The regents establish by-laws and rules for the government of the hospital, fix the salaries of officers and attendants, not otherwise provided for by law, and establish the rates of admission, mainte- nance and medical attendance for patients other than beneficiaries. The superintendent appoints and removes all officers and em- ployees and makes all rules for the institution. The governor ap- points a visiting board of one physician, one minister of the Gospel and one layman, who inspect the hospital and report to the governor each month. 2. CARE a. In state institutions. State Hospital for the Insane, Columbia; established 1821; 1,700 beds. There are separate departments for white and colored patients. b. In local institutions. The indigent insane not admitted to the state hospital because harmless or incurable are maintained in the county poorhouses under the charge of the county commis- sioners, except in the cities of Charleston and Columbia where the city authorities are the overseers of the poor. 3. COMMITMENT a. Persons committed. The state hospital for the insane is maintained solely for the custody and treatment of insane persons. A person is considered insane or fit to be a patient in the hospital who by reason of mental aberration of a more or less permanent character is dangerous to others or to his own life or person, or to 223 SOUTH CAROLINA property. Lack or loss of mental ability to properly conduct his usual work or business must be considered along with aberrant con- duct in determining the question of a person's insanity. Harmless imbeciles, idiots or epileptics may not be maintained at the hospital except as pay patients. No non-resident of the state may be admitted to a state hospital. 3368 - If the resident of some other state is found to be insane the judge of probate informs the governor of the other state and unless its authorities remove the insane person within a reasonable time the county commissioners have him conveyed to the state of his citizen- ship. In the case of a foreigner the governor transmits the informa- tion to the secretary of state of the United States. Inebriates or persons addicted to the drug habit may not be Inebriates - received in the state hospital for the insane for treatment, unless they are dangerous or violent. The board of county commissioners of the respective counties from which such persons are sent, if beneficiaries, must pay to the state hospital for their maintenance the same sum upon the same terms required for pay patients. Any inebriate or person addicted to the drug habit, who voluntarily makes application for admission to the hospital, may at the discre- tion of the board of regents be received as a pay patient; but not when the accommodations are inadequate for insane patients. b. Legal procedure in commitment. Application by a relative, Application, friend or citizen for commitment of an insane person to the hospital must be made to the judge of probate of the county in which the alleged insane person resides. The judge may investigate the case by examining witnesses or not as he sees fit, and if he is reasonably convinced that the application is a just one, he must transmit an- swers to the list of interrogatories prepared by the regents, and for- ward them to the superintendent of the hospital with an application for admission. If necessary the superintendent may refer the ap- 336a - plication to the board of regents before final answer. When informed that the person can be received, on what terms, and under what class, the judge of probate must call two physicians to certify to the insanity of the person. The physicians must be registered according to the law of the state and may not be related to the patient. They must certify that he is not an epileptic, a lunatic incurable at home, and that he is violent and dangerous. If the judge of probate believes that satisfactory evidence has been offered of the person's insanity, he must make certificates as re- quired by the board of regents, and send the insane patient to the hospital. The superintendent of the state hospital may receive and detain f a |s ge for a period not exceeding five days, without an order from the 3363. SOUTH CAROLINA 224 probate judge, any person as insane whose case is duly certified by two reputable physicians to be one of violent and dangerous in- sanity. In addition, an application signed by a magistrate of the county or the mayor or alderman, intendant or warden of the county, city or town in which such insane person resides or is found, must be left with the superintendent. The party committing the person must give a bond in the sum of $100 to the treasurer of the institu- tion, with condition that he will within five days procure an order for his commitment, and failing this that the insane person must be removed or discharged by the superintendent. 3357. When the accommodations of the hospital are crowded, preference must be given to recent curable cases over chronic incurable cases. Preference is last given to idiots, or any who have been imbecile or weak-minded from childhood, to those who are subject to epileptic convulsions, and to those whose temporary insanity is produced by the use of alcoholic drinks or opiates. 3376. The sheriff or other person in charge of any patient ordered to be conveyed to the state hospital for the insane must hold him without expense to the hospital until notified by the superintendent that the patient can be received. A i! f IS)I5 ' Ct Voluntary admission. Any person making application for admission may be received at the discretion of the superintendent. Parties liable. e< Cost of commitment. The expense of committing patients and transporting them to the hospital must be paid out of their estate if they have any, or by the relatives liable for their support. In the case of indigent patients the cost is borne by the state. 4. CONVEYING PATIENTS TO THE HOSPITAL a"hits ^ke J u dg e f probate must deputize the sheriff or his deputies or attendant. other officers or a friend or friends of a committed insane person, to convey him to the hospital. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS t B endentf uperin " The superintendent of the hospital, under the authority of the C 3 d 7o board of regents, must furlough any convalescent patient at the request of his relatives or friends for a period not exceeding three months. The relatives or friends must pay all the traveling ex- penses of the patient from and back to the hospital. If at the expiration of three months the patient has not been returned to the hospital, he must be entered as discharged, and re-admission can not be obtained without recommitment as if the person had never been a patient in the hospital. 3378. Whenever a patient has recovered, the regents must discharge him from the hospital. 225 SOUTH CAROLINA 7. COST OF MAINTENANCE Indigent patients, residents of the state, are maintained at the expense of the state. The judge of probate must make a thorough examination of disinterested, reliable witnesses under oath, and of records, as the financial standing of the patient, the actual value of all property 3365. owned by him, and by the husband, wife, father, mother, sons, daughters of such patient, and also a statement of all debts due to" and due by the patient and the relatives, and transmit to the superintendent of the hospital a report of his investigation. The superintendent or the board of regents must then decide whether the patient can be received as a beneficiary or as a paying patient, in whole or in part. If the patient is to be a paying patient the judge of probate must require a bond to be given with sufficient sureties. If satisfactory evidence is adduced before the judge of probate that a paying patient in the hospital has since admission become indigent, he must at once notify the superintendent of the fact. The board of charities must investigate the financial condition ^^? of all inmates and relatives liable for their support, having due Ac )| f I9IS> regard for others dependent for support on the patient's estate. All the information in each case with conclusions and recommenda- tions are submitted to the board of regents of the state hospital which then decides what charges shall be made and collects the amounts, if necessary calling on the attorney general for aid. The state board of charities may cancel or modify any such order. 8. CRIMINAL INSANE Any judge of the circuit court is authorized to send to the state g^g ^^ hospital for the insane every person charged with the commission of %%$* any criminal offense, who upon trial proves to be non compos mentis. 3375. When the person so sent is not a pauper, he must be supp.orted out of his own estate. 226 SOUTH DAKOTA Authorities: Compiled Laws of South Dakota, 1913. Laws of South Dakota, 1915, 1917 i. ADMINISTRATION AND SUPERVISION nd a> General. The state board of charities and correction is correction. composed of five persons, no three of whom may be residents of p - 45 - counties in which any state public institutions are located, ap- pointed by the governor for terms of six years. The board has control of all state institutions including the hospitals for the insane, with power to examine all that pertains to the management and condition of these institutions and to demand information. In p-4sa. addition, the board has all the powers formerly possessed by the Laws of 1917, ch. 266. boards of trustees of the several institutions, including the appoint- ment for the hospitals of the insane of medical superintendents, assistant physicians, stewards and matrons. c. L f the person in question or from others who know the facts correct an- swers, so far as may be, to the prescribed interrogatories, which with answers must be attached to his certificate. On the return of the physician's certificate, the commissioners Flings, must find whether the person is insane and a fit subject for treatment SOUTH DAKOTA 228 Preference in receiving patients, p. 145. Disposition of insane person when accom- modations of asylum are insufficient. P- 735- Insane persons cared for by the county. P. 735- Laws of 1915, ch. 285. Laws of 1917, ch.:66. Proceedings for release. C. L. P. 737 and custody in the hospital, and where his legal settlement is. If they find him insane and a fit subject for treatment and custody in the hospital, they must issue their warrant authorizing the superin- tendent of the hospital to receive him as a patient. If it becomes necessary for want of room or other cause to dis- criminate in the general reception of patients into the hospital, a selection must be made as follows: (1) recent cases, of less than one year's duration; (2) chronic cases, of more than one year's duration; (3) those for whom application has been longest on file; (4) when cases are equally meritorious in all other respects, the indigent are to be preferred. When it is shown to the satisfaction of the commissioners that persons found insane can not at once be admitted to the hospital, and that they can not with safety be allowed to go at liberty, they must require suitable provision to be made for them until admission can be had, or until the occasion therefor no longer exists. Such patients may be cared for as private patients when relatives or friends obligate themselves to take care of and provide for them without public charge. In such cases, the commissioners must ap- point a suitable person a special custodian, to restrain, protect and care for the patient. Or they may be cared for as public patients, in which case the commissioners must place them in charge of the commissioners of the county or overseers of the poor, at the expense of the county. For lack of a poorhouse for the reception of such patients, or if no more suitable place can be found, they may be confined in the county jail. Or the commissioners may require that such patients be taken to the asylum of any state designated by the governor, who is authorized to arrange terms for this purpose. Persons alleged to be insane and whose admission to the hospital is not sought, may be provided for as either public or private pa- tients in the county by the commissioners upon proof of their in- sanity and need of care; provided, however, that if any inmate of the South Dakota Soldiers Home is adjudged insane, he must be cared for at the hospital for the insane at the expense of the state. c. Voluntary admission. Any person may receive treatment at the state hospital by subjecting himself to the custody and control of the superintendent and paying quarterly in advance the sum of sixteen dollars per month. d. Appeal from commitment. On a statement in writing, verified by affidavit, to the county judge of the county in which the hospital is situated, or of the county in which any person confined in the hospital has his legal settlement, that he is not insane, the judge must appoint a commission of not more than three persons to inquire into the merits of the case, one of whom must be a physician; and another 229 SOUTH DAKOTA an attorney, if two or more are appointed. Their report to the judge must be accompanied by a statement of the case and signed by the superintendent. If on such report the county judge finds the person not insane, he must order his discharge; if not, he must authorize his continued detention. The cost of the inquiry is to be paid by the county if the applicant is found to be sane; if not, then by the applicant. The commission provided for may not be re- peated oftener than once in six months in regard to the same pa- tient, and may not be appointed within six months of the time of the admission of any patient. All persons confined as insane are entitled to the benefit of the J^ as corpus - writ of habeas corpus, and the question of insanity must be decided at the hearing. If the judge decides that the person is insane, the decision is no bar to the issuing of the writ a second time, whenever it shall be alleged that he has been restored to reason. e. Cost of commitment. The cost of committingan insane person ^ O a j^ t by the is a charge upon the county in which he has a legal residence, but P- 734. the expense of conveying patients to the hospital is paid out of the state treasury, although advanced by the county. 4. CONVEYING PATIENTS TO THE HOSPITAL When a person is to be sent to the hospital, the superintendent ^^'1917 must send an employee, who has had experience in the care of in- ch - 26 s- sane persons, to take charge of him while en route to the hospital. The expense is paid by the state. , The county judge may authorize a relative or member of the JjJJ^- Igi? family of the insane person, or some other person if competent to do ch - a6 s- so and the superintendent assents, to convey him to the hospital for the insane. Female patients must be accompanied by a female attendant. 5. TRANSFER OF PATIENTS Insane persons who have been under care as public or P^v patients outside of the hospital by authority of the commissioners of c - L - 6 any county, may on application be transferred to the hospital, whenever they can be admitted, without another inquest at any time within six months. 6. PAROLE AND DISCHARGE OF PATIENTS Any patient who is cured must immediately be discharged by the superintendent. The relatives of any patient not susceptible o cure, and not dangerous to be at large, have the right to remove him by consent of the board of charities and correction. On application of the relatives or immediate friends of any patient in the hospital who is not cured, and who can not be safely allowed to go at liberty, SOUTH DAKOTA 230 the commissioners of insanity of the county in which the patient belongs, having made provision for his care within the county, may authorize his discharge from the hospital; but no patient charged with or convicted of homicide may be discharged without the order without 86 ^ ^ e board. When patients are discharged from the hospital application. without application therefor, notice must at once be sent to the commissioners of insanity of the county where they belong, who must have them removed, and provide for their care in the county, unless the patients are discharged as cured. If the commissioners fail to remove a patient so discharged within thirty days, the county in which the patient belongs must pay at the rate of two dollars per day for the support of the patient at the hospital. 7. COST OF MAINTENANCE state ged to the ^e ex P enses f r the care, board and keeping pf patients in the chT66 f I9I7> hospital for the insane is paid by the state. If the inmates are able to do so, they may be required to pay sixteen dollars per month into the county treasury. Non-residents may be received upon payment of cost of maintenance in advance quarterly payments. 8. CRIMINAL INSANE ^raunation if a doubt arises as to the sanity of a defendant to be tried on C 'p L 7J5 indictment or brought up for judgment, the court must order a jury to be impaneled. If the jury finds the defendant is insane, the trial or judgment must be suspended until he becomes sane, and the court, if it deems his discharge dangerbus to the public peace or safety, may order him to be kept in charge of the sheriff until sane. ^ tne defence is insanity, the jury must state the fact if they acquit him on that ground; and the court may, if it considers the discharge of the defendant dangerous, commit him to the hospital for the insane until he recovers. convicts Whenever it appears to the satisfaction of the governor, by the P. 746. representations of the warden of the state prison and board of charities and correction, that a convict sentenced by any court in the state has become insane, the governor, if he determines that the convict is insane, must order him transferred to one of the state hospitals for the insane, and that upon recovery, if before the expira- tion of his sentence, he be returned to the state prison. 231 TENNESSEE Authorities: Annotated Code of Tennessee, 1917 Public Acts of Tennessee, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of control consists of three electors Board of con- trol. one from each grand division of the state, appointed .by the gov- Co ^ & 2 ernor, with the advice of the senate. The governor designates the president, and the board elects one member vice-president and the other, fiscal supervisor. The board appoints its secretary and other employees. Members hold office for six years but are removable by the governor. The salary of the president is $4,000; that of the other members, S3, 600; actual official traveling expenses are al- lowed. The members devote their entire time to their official duties and 3"a 68. have all power and authority necessary for the full and efficient exercise of administrative, executive, and fiscal supervision over all the state institutions. The board determines the number of officers and employees and fixes their salaries. It may discharge any employee. All supplies are purchased by the board. Each in- stitution must be visited at least once a month by a member of the board. The board reports annually to the governor. Private institutions for the insane may be established under the ,? r s^| ions direct control of a physician in charge, who must be a reputable and. a6 ?7a 3- licensed physician, a graduate of a recognized medical school, with at least five years' experience in treating insanity. A license must be obtained from the clerk of the county court in which the proposed institution is located. No license may be granted until the appli- cant delivers to the clerk a sworn statement of the proposed physician in charge, showing that he is properly qualified. b. Institutional. There are no local boards of trustees. Each Superintend- ents. state hospital is under the executive management of a superintend- ent appointed by the board of control, subject to the approval of the governor, for a term of four years, unless removed after a hearing on charges. He appoints the necessary employees but not more than ten per cent of the total number may be from the same county. The superintendents are the treasurers of their respective hospitals and must give a surety bond. 2. CARE a. In state institutions. Central Hospital for the Insane, Nashville; established 1852; 700 beds. TENNESSEE 232 County asylums. 1932. 2616. 2617. Indigents. 2630. Private institutions. 26778 6. 2<577a 7. 26778 8. 26773 10. 2677* ii. Eastern Hospital for the Insane, Bearden; 'established 1886; 620 beds. The Western Hospital for the Insane, Bolivar; established 1889; 700 beds. b. In local institutions. Four counties maintain asylums for the insane or insane departments in connection with the almshouses, under the management of the commissioners of the poor elected by the county. Each of the other counties must maintain its own poor asylum, to which the insane may be admitted who can not be cared for at the state hospitals. The rulings of the county commissioners in regard to admissions are subject to revision by the county court. 3. COMMITMENT a. Persons committed. All insane persons who have legal citizen- ship and residence in the state may be admitted to the state hospitals. b. Legal procedure in commitment. Insane persons may be placed in a hospital by their legal guardians or by their relatives or friends in case they have no guardians, or by a justice of the peace, upon proper proof of their insanity. In order of admission, the indigent insane of the state have pre- cedence of paying patients, and recent cases of both classes have precedence over those of long standing. An insane person may be committed to a private institution in the same manner as provided for the commitment of insane persons to the state or county hospitals for the insane. Or commitment may be made upon a petition to the chancery or county court by the husband, wife, child, parent, brother, or sister, or guardian, or the next of kin of the alleged insane person, or by the person at whose house the alleged insane person resides, and a certificate of lunacy made by two reputable physicians of at least two years' experience in the practice of medicine, and upon the order of a judge of the court. The petition must contain a sworn statement of the degree of relationship of the alleged insane person, his color, sex, age, civil condition, occupation, place of residence, and duration of his in- sanity, the f^icts indicating his insanity, and the name of the in- stitution to which it is desired to have him committed. The two physicians must jointly make a final examination of the alleged insane person within ten days next before the granting of the order of commitment. Neither of the physicians may be a relative of the person applying for the order of commitment, or of the insane person, or be an officer of or be in any way pecuniarily interested in the institution to which commitment is sought. Personal notice of the application for his commitment must be served upon the alleged insane person at least 233 TENNESSEE one day before the order is granted; but the, judge may dispense with such personal service upon the affidavit of the examining physicians that it would be detrimental to the patient. When the condition of an alleged insane person renders necessary ^|g gency his immediate confinement in an institution for the insane, a private 2677a I4< institution may receive him upon the petition and certificate of lunacy for a period of time not exceeding five days, and before its expiration, an order must be secured for his regular commitment. In such a case, the medical examiners must certify that the person in question should immediately be confined in an institution for the insane. ' , Inmates of institutions and persons held for commitment proceed- JJ^JJ of ings who flee from the state may be returned to the state and to the ^"ifo *f ', institution upon the requisition of the governor. Fugitives from other states may be returned upon the requisition of the governor of the state from which the person fled. c. Voluntary admission. d. Appeal from commitment. An alleged insane person may g^^ prosecute an appeal or a writ of error, in proper person, from an note 6 - adverse judgment in a proceeding of inquisition of lunacy. Any person restrained of his liberty may prosecute a writ of habeas Habeas corpus, corpus, to be granted by any judge. e. Cpst of commitment. The county from which an indigent person is sent must pay the expense of his transportation to and from the hospital as well as other expenses connected with his commit- ment. 4. CONVEYING PATIENTS TO THE HOSPITAL The clerk of the county has the duty of issuing a warrant to some suitable person for the conveyance of an insane patient to a hospital. 5. TRANSFER OF PATIENTS An insane person may be transferred from the custody of a state a677a l &- or county asylum or hospital to the custody of a private institution, or vice versa, upon a certified copy of the original order of commit- ment made by the superintendent or physician in charge of the institution from which the patient is transferred. 6. PAROLE AND DISCHARGE OF PATIENTS Patients in state hospitals must be removed whenever, in the P|$ tiong judgment of the superintendent and the board of control, it may be 26ait judicious and proper for the interests of the hospital, the patient, and the community. The physician in charge may at any time discharge a patient J5^ OM committed to a private institution as insane when, in his opinion, 2627816. TENNESSEE 234 indited. 3631. the patient has recovered, or his condition does not render him dangerous to himself or others if at liberty, or may discharge him to custody of a person authorized to make the petition. Tne Physician in charge of a private institution may parole a committed insane person to the custody of a responsible relative or friend for a period not exceeding thirty days. If the patient is returned to the institution before the expiration of that time, he may be re-admitted upon the original order of commitment. Be- fore the expiration of this period of thirty days, he may in like manner be admitted to any state or county hospital or asylum or other licensed private institution for the insane upon a certified copy of the original order of commitment. If not returned to the custody of the institution or admitted to some other institution upon the original order, he must be discharged at the expiration of his period of parole. 7. COST OF MAINTENANCE The county from which an indigent patient is sent must pay the cost of his maintenance at the hospital and provide the necessary clothing. When a person committed to the hospitals for the insane has estate, the income of which is insufficient to pay for his support at the hospital, the same may be appropriated toward the payment for his support; provided, that the patient has no family or dependents. -pjjg county court clerks of the various counties are required to report to the superintendents of the several hospitals for the insane the names and amounts in value of the estates belonging to insane persons who have been committed. 8. CRIMINAL INSANE A court if satisfied that a person indicted for a criminal offense has been insane for four successive terms may discharge him upon recognizance of sufficient sureties for his appearance at the next term, and may renew this recognizance from term to term so long as the defendant continues insane. If in behalf of a person not previously known to be insane who is charged with a criminal offense punishable by imprisonment in the penitentiary or death, the plea of insanity is urged, the court must charge the jury that if they believe the defendant to be insane, they shall so find, and he shall be committed to a hospital. The powers of courts to commit to the hospital for the insane do not extend to insane persons arraigned for felonious assaults or misdemeanors only, or to those who may be admissible to the hospitals for the insane under the general laws of commitment. 235 TENNESSEE When, in the opinion of the board of control and superintendent, J a patient committed as criminal insane has recovered, they niust deliver him to the jailor of Davidson county for safe-keeping, and notify the clerk of the county in which he was arraigned of the fact. If, at the next term of the court, the district attorney wish further to prosecute such person, he must be delivered to the jailor of the county in which he was arraigned. 236 TEXAS Authorities : Vernon's Sayle's Texas Civil Statutes, 1914 Laws of Texas, 1917 i. ADMINISTRATION AND SUPERVISION a. General. There is no state board having general control or supervision of the insane or of the institutions in which they are kept. b. Institutional. The general control, management and direction ^ *ke an?a i fs f tne Texas hospitals for the insane are vested in boards of managers, each hospital having its own board consisting of 'oo. six members, appointed by the governor for terms of six years. The board of managers has power to make all necessary by-laws "3. and regulations for the institution and its inmates; to elect a super- intendent; to make all other appointments on, the nomination of the superintendent; to determine salaries and wages, to discharge upon the recommendation of the superintendent any officer or employee or patient, etc. superintendent. The superintendent must be a married man, a skillful physican and experienced in treating cases of insanity. 2. CARE a. In state institutions. State Lunatic Asylum, Austin; established 1857; 1,680 beds. North Texas Hospital for the Insane, Terrell; established 1885; 1,900 beds. Southwestern Insane Asylum, San Antonio; established 1891; 2,000 beds. The 1917 session of the legislature provided for the establishment of the Northwest Texas Insane Asylum and for the establishment of an Asylum for the Negro Insane at Rush. b. In local institutions. In counties having almshouses the in- sane who can not be admitted to the state hospitals may be cared for in them. The county commissioners have responsibility for such case^ and manage the almshouses. 3. COMMITMENT P rivate an ^ ftt P ersons committed. All persons who have been judged insane tients. by a court of competent jurisdiction (public patients) are entitled to admission to the state hospitals. Persons certified to be insane by ***' some reputable physician in accordance with law (private patients) may be admitted. Idiots who can safely be kept in the county in 237 TEXAS which they belong and persons suffering from an infectious or contagious disease are excluded from the hospitals. b. Legal procedure in commitment. Before any person can received at a hospital as a patient, the parent or legal guardian of such person or some near relative or other person interested must present a written request to the superintendent, giving such particu- lars as may be required. The request must be under oath and ac- companied by an affidavit of the examining physician showing that he has made a careful examination of the patient, and thoroughly believes him to be insane, and by a certificate from the county judge of the county where the alleged insane person resides. A complete history of the patient must be forwarded to the medical superintend- ent with the application for admission. If an affidavit be filed with any county judge or justice of the peace Affidavit, that any person in the county needs to be placed under restraint because of insanity and the judge believes the statement true, the county judge sets a hearing of the case before a commission of six I 5 2 - men, as many as possible of whom shall be physicians, and depending upon the population from one to six must be physicians. (This provision requiring that physicians sit on trtie commissions has been declared unconstitutional by certain county judges but is observed in most parts of the state.) The affiant of the affidavit is repre- sented by the county attorney and the respondent must be repre- sented by counsel secured by himself or appointed by the judge. The various issues to be submitted to the commission are minutely specified, and relate not only to the question of the defendant's sanity or insanity, but to his age, nativity, the character of attacks and their duration, whether insanity is hereditary in his family, whether the defendant is possessed of any estate, and whether there are any persons legally liable for his support. Upon the return a majority report that the respondent is of unsound mind and should be placed under treatment and restraint, the county judge must pronounce judgment in the presence of the respondent and order him conveyed to one of the lunatic asylums. The judge shall then ascertain if there is a vacancy. If accommodations can not be provided for all persons for whom application has been made, preference must be given in all instances to public over private patients, and of the former class, to cases of less than one year's duration over chronic cases. No private patient may be admitted during the pendency of an application by a public patient. c. Voluntary admission d. Appeal from commitment. by the county. TEXAS 238 e * ^ ost * commitment. The cost of commitment and of trans- porting an insane person to a hospital is paid by the county from which he is sent unless he has sufficient estate to bear the expense. 4. CONVEYING PATIENTS TO THE HOSPITAL Upon the warrant of the county judge, the sheriff or some other suitable person must convey him to the hospital. A female patient must be accompanied by a woman or by her husband, father, brother, son, uncle or nephew. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS ^ patients, except those charged with or convicted of some of- board. fense and adjudged insane, may be discharged from a hospital at any ' time upon the recommendation of the superintendent approved by the board of managers. Any patient coming within the above ex- ception may only be discharged upon order of the court by which he was committed. 7. COST OF MAINTENANCE Public patients. All indigent public patients are maintained at the expense of the state. All public patients not indigent must be maintained at the J 3 8 - expense of the state in the first instance, but in such cases the state is entitled to proper reimbursement. "41. The commissioners court has power to provide for the support of idiots and lunatics who can not be admitted into the lunatic asylum, residents of their county, who are unable to support themselves. By the term resident as used herein, is meant a person who has been a bona fide inhabitant of the county not less than six months and of the state not less than one year. 8. CRIMINAL INSANE wmmitoent ^he P rocess f commitment is the same as for an insane person not I6 s- a convict (Section 3, b) except that when the person is confined in the state penitentiary all proceedings and hearings must be held there. 144. When a convict is discharged from a state penitentiary, and is insane at the time of his discharge, and is so adjudged by a competent court within thirty days, he must be conveyed to one of the hospitals for the insane, at the expense of the state. 239 UTAH Authority: Compiled Laws of Utah, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of insanity, consisting of the governor, state treasurer and auditor, has the supervision and control of all insane persons in the state, whether they reside in the hospital or 5390. some other place. The board of insanity has the general control and management S38p ' of the affairs of the state mental hospital. It is required to hold monthly meetings at the hospital and must make a careful inspection of the institution at least once in three months. b. Institutional. There is no local board of trustees. The med- ical superintendent, who is appointed by the state board of insanity, must be a well-educated, experienced physician who has practiced five years. With the approval of the board, he appoints all attend- ants and employees, fixes their compensation and has power to remove them. 2. CARE a. In state institutions. State Mental Hospital, Provo; established 1885; 500 beds. b. In local institutions. The county commissioners, who are the overseers of the poor, are bound to provide for such insane as may not be received at the hospital and may care for them at poor farms or other institutions. 3. COMMITMENT a. Persons committed. All insane persons who are residents of 5405. the state are entitled to admission to the hospital, also feeble- 5384. minded and noninsane epileptics capable of mental improvement, but other feebleminded, a purely senile dement, a person in an unconscious condition, an infant, a child under ten years of age, and a person suffering from a contagious or infectious disease are not admitted. b. Legal procedure in commitment. Application for admission of ^fj^ 081 patients must be made to the judges of the district courts, except in 5398. cases otherwise provided for. In the absence of a district judge, the judge of any other district may act upon the application at the written request of the clerk of the district court of the county wherein the alleged insane person resides, or the chairman, of the board of county commissioners may so act. UTAH 240 Form of applicatic 5400. Judicial hearing. 540i. Certificate of physicians. 5403. Commitment of non- residents. 5412. The application for admission to the hospital must be in the form of an information, properly verified, alleging the person for whom application is made to be insane, and a proper person for care and treatment, and stating facts in regard to his residence, etc. The district judge of the county may examine the informant under oath and require the person for whom admission is sought to be brought before him. If satisfied that there is reasonable cause, a hearing must be had, and the district attorney notified. Any citizen of the county or any relative or a friend of the person for whom ap- plication is made may resist the application, and may appear by counsel. The district attorney must represent the state in such examination. The judge must summon two practicing physicians before whom the examination is to be conducted. The physicians must certify under oath whether or not the person is insane, whether the case is of recent or curable character, whether the person has a homicidal, suicidal or incendiary mania. They must also obtain from others correct answers to the interrogatories of the certificate as prescribed by law. If the judge upon the conclu- sion of his investigation finds the person insane, and one who ought to receive care and treatment at the hospital, he must order his commitment. When discrimination in reception of patients is necessary, they take precedence in the following order: 1, cases of less than one year's duration; 2, chronic cases of more than one year's duration presenting the most favorable prospects for recovery; 3, those for whom application has been longest on file. When cases are equally meritorious, indigent patients are to be preferred. . When notified by the board of insanity or the superintendent of the hospital that a person committed to the hospital can not be received for want of room, the board of county commissioners must provide suitably for him until admission can be had, or the occasion for it no longer exists. Nonresidents of Utah, conveyed to or coming into the state, may, upon the written recommendation of the board of county commis- sioners, be returned by the board of insanity to their homes or friends, and must not be permitted to be supported in the hospital. But persons stricken with insanity while traveling through or temporarily sojourning in the state may be committed to and cared for temporarily in the hospital. c. Voluntary admission. d. Appeal from commitment. Upon an affidavit or other evidence that a patient in the hospital is not insane or not a proper person to be cared for at the hospital, the board of insanity must ask in- quiry by the district judge of the district in which the patient is 241 UTAH held. If the patient is found to be sane, he must be discharged; if not, the judge must order his continued detention, and may order the parties demanding the inquiry to pay its cost. e. Cost of commitment. The cost of commitment is paid by the S4. county from which the patient was sent unless he has estate suffi- cient to pay the same. 4. CONVEYING PATIENTS TO THE HOSPITAL The sheriff or other person appointed to execute the warrant of the MOS- district judge must convey the patient to the hospital and deliver him, together with the copies of information, physicians' certificates and warrant, to the superintendent of the hospital. No f emale j^Sfdant may be taken to the hospital without the attendance of some other 54". female or relative. If any relative or immediate friend, who is suitable, shall request, he has the privilege of executing the warrant in preference to the sheriff. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS By order of the judge of the district court issuing the commit- ** court - ment, a patient may be returned to his relatives or friends. Applica- tion must be made to the judge, and satisfactory evidence produced that the patient will be given proper care. The applicants must give bonds to the district court of the county. If subsequently it is Bond required, brought to the knowledge of the judge that a person thus removed from the hospital is not properly cared for or is not fit to be at liberty, he may order the return of such person to the hospital; but no patient under a criminal charge or conviction may be discharged from the hospital without the order of the court having jurisdiction of the case. If it appear upon sufficient evidence that any patient MIS. in the hospital is not insane or is unjustly deprived of his liberty or is not one who should receive care and treatment in the hospital, the board of insanity must request immediate inquiry by the district judge who may order his immediate discharge. When it becomes necessary for want of room or other cause to By *^ board- remove any patient, the superintendent must give notice to that effect to the several clerks of the district courts. Only harmless and incurable patients may be removed by the board of insanity.' 7. COST OF MAINTENANCE The state pays the cost of maintaining all indigent patients. In 5410. case a patient has sufficient means to pay any part of the cost of 5408. maintenance at the hospital, the judge must appoint a guardian 5853. for him. The immediate relatives of an insane person are liable for his support. UTAH 242 Recovery for support. 5417. Persons ex- cused from crime. 9328. 9329. Commitment. Expense of examination. 9335. Provision is made for the reimbursement to the state from the estate of persons declared insane and for the recovery of expenses of commitment and support in the case of nonindigent persons, for the appointment of a guardian under bond in the case of nonindigent insane who are committed, and for recovery from persons liable for the support of an insane relative. 8. CRIMINAL INSANE When a person charged with crime has escaped indictment or been acquitted on trial by reason of insanity, or when a person during trial or while confined as a criminal in the state prison or a county jail becomes insane, the district judge of the bounty must act in the case and may submit the matter to a jury. If the jury find the defendant insane, he must be committed to the state mental hospital, provided, the court deems his freedom a menace to public quietude. Proceedings against the defendant must be suspended until he becomes sane. A person thus committed must be detained at the hospital until he becomes sane. If then his sentence has expired, he must be restored to liberty. Otherwise, the superintendent must give notice of his recovery to the sheriff of the county from which he was sent, who must place him in proper custody until he is brought to trial or judgment, or return him to prison to serve out the remainder of his term. The time of his confinement in the state mental hospital must be deducted from his term. The expenses of the examination and sending of such persons, except convicts in the state prison, to and from the state mental" hospital, are chargeable to the county from which they have been sent. But the county may recover from their estates, or from a relative legally bound to care for them, or from the county of which they may be resident. In the case of an indigent insane convict, the costs are borne by the state. 243 VERMONT Authorities: Public Statutes of Vermont, 1906 Laws of Vermont, 1908, 1910, 1912, 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The board of control consists of the governor, state *>L f treasurer, auditor of accounts, director of state institutions and a^ ws fl person appointed by the governor with the consent of the senate for a term of two years. The members receive their expenses while engaged in official business, except the member appointed by the governor who receives in addition eight dollars a day for the actual time spent in his official capacity. The board has power to examine each institution of the state and 4 8 - require monthly reports from them. If the money appropriated for the support of the institution is not being properly expended, further expenditure may be prohibited. The board must hold monthly meetings at the capitol or else- where, and must annually or as often as deemed proper visit each institution under its control, inspect the management and hear complaints of the inmates and direct changes which must be made by the director of state institutions. The board must report biennially to the legislature. The governor may appoint a woman to accompany the board upon woman vi its visits for the purpose of inspecting and investigating the care of female inmates. The woman visitor receives five dollars a day and expenses while visiting institutions. The director of state institutions, who is appointed by the gov- ernor with the consent of the senate for a term of two years, has the o ns j is general care, control and management of all the state institutions, including the hospital for the insane. All the powers, duties and liabilities of the former boards of trustees of the various state institutions are imposed upon him. He receives a salary of $3,000 a year and expenses, and devotes his entire time to the duties of his office. The director makes all needful rules and regulations for the {f w | f I9 "' government of the institutions, employs and removes at pleasure jj* w | f I9IS * all physicians, teachers, clerks and employees, and fixes their com- pensation. He must visit the institutions as often as once a month and must make a yearly investigation of their accounts and report biennially to the governor. b. Institutional. There are no local boards of trustees. VERMONT 244 2. CARE a. In state institutions. Vermont State Hospital for the Insane, Waterbury; established 1888; 700 beds. The state also supports patients in a hospital under private management: Brattleboro Retreat, Brattleboro; established 1834; 400 beds. b. In local institutions. Insane persons who can not be cared for in the hospitals may be kept at almshouses under the charge of the overseers of the poor of the town. Certificate of insanity. P. S. 3753- 3754- 3755- 3756. Commitment on order or sentence of court. 3760. Superintendent may receive. 3764. Review of the case. 5757- 3. COMMITMENT a. Persons committed. All insane persons, residents of the state are entitled to admission to the hospitals for the insane, except idiots and demented persons when they are not dangerous. b. Legal procedure in commitment. Admission to a hospital for the insane as a patient or inmate is upon a certificate of insanity made by two legally qualified physicians, residents of the state. The physicians must not be members of the same firm, officers of a hospital for the insane in this state, nor members of the board of control. The physicians must make oath to the certificate before a magistrate, who must append his jurat, and certify that said physicians are of unquestionable integrity and skill. The certificate must not be made more than ten days before the admission of the in- sane person to the hospital for the insane, unless a longer time is re- quired to dispose of an appeal taken from the decision of the physicians. The physicians are required to examine the supposed insane person not more than five days previous to making the cer- tificate; and a physician who signs a certificate without making a previous examination shall, if the person is admitted to a hospital for the insane upon the certificate, be imprisoned not more than two years or fined not more than $1,000, or both. A person may be received into a hospital for the insane pursuant to an order or sentence of the supreme or county court without the physicians' certificate. c. Voluntary admission. The superintendent of a hospital for the insane may receive as a voluntary patient, a person who seeks treatment and makes written application without a certificate of two physicians. He may not be detained after having given 48 hours' notice in writing that he desires to leave the institution. d. Appeal from commitment. The next friend or relative of a person whose insanity is so certified may appeal from the decision of the physicians to the state board of control for a review of the 245 VERMONT case. An alleged insane person may not be received in a hospital for the insane while an appeal is pending before the board of control. e. Cost of commitment. The costs of the examination and 3720. removal of an insane person are chargeable to the town of his resi- dence when the town authorities seek his commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The board of control may discharge conditionally an incurable ^^^"^ T insane person from a hospital, subject to revocation. It may dis- Int 3 e 4 d 6 ent - charge any person wrongfully confined or so far sane as to warrant 37 g7- discharge, but not without giving the superintendent opportunity to be heard. The superintendent of the state hospital or of the Brattleboro Retreat may grant a furlough of not exceeding thirty days to any patient or inmate under his charge supported in whole or in part by the state, and may extend it in his discretion, not exceeding thirty days in the aggregate. 7. COST OF MAINTENANCE Insane persons in a town, destitute of means of support, and hav- ing no relatives in the state bound by law to support them, are %"? lpl7 supported by the state while in a hospital for the insane. On ap- p - 3 ^ i6 plication of the overseer of the poor of such town, the selectmen j^ s x f I9I7 or the county auditor upon his own motion must ascertain whether the insane person is liable to be supported by -the state, and may institute a court of inquiry before the judge of probate. The 1 *- 8 ^ inquiry must be attended by the state's attorney of the county for the protection of the interests of the state. When a person is lawfully discharged from a hospital or the ^w* ot Retreat, the town causing his commitment must take charge of and discharged, support him. No patient may be supported in the state hospital or the Retreat ^^ in entirely at the expense of the state unless he is removed upon the 3733- order of a judge of probate, or from the state prison or house of correction, or upon the order or sentence of the supreme or county court. 8. CRIMINAL INSANE A county judge, if satisfied that a plea of insanity will be made in behalf of a person indicted for a criminal offense, may order him to be detained at the state hospital till the truth of the plea can be ascertained. VERMONT 246 When an indictment is not found or a person is acquitted of a criminal charge on the ground of insanity, the court may commit the person to the county jail or to the state hospital. He may be discharged only on the order of the county court by which he was committed. ^ ne su P erm tendent of the state hospital must receive all insane criminals ordered committed, for whom separate accommodations are provided. A person confined in the state prison or house of correction or a county jail for a specified time, or for life, who becomes insane may be removed to the Vermont State Hospital for the Insane only upon the order of the governor after expert examina- tion as to his insanity, to remain until the expiration of the term for 6o6a. which he was committed. If he becomes sane before its expication, he must, upon the order of the governor, be returned to the institu- tion to which he was originally committed and confined there for 6064. the remainder of such term. A prisoner who, at the expiration of his term of confinement, remains insane, may be removed to the state hospital; or if already there, may remain, at the expense of the state, until his residence is ascertained or some relative is ordered by the proper court to furnish his maintenance. 247 VIRGINIA Authorities : Code of Virginia, 1904 Supplement to Code of Virginia, 1910 Laws of 1911, 1916 i. ADMINISTRATION AND SUPERVISION a. General. The state board of charities and correction is B , ar . of . chanties and composed of five members, appointed by the governor for terms five years, subject to removal by him for cause. Failure to attend p - 797 - at least one meeting during the year, unless excused, may be con- 3 - strued by the governor as a resignation of the non-attending member. The duties of the board are strictly visitorial and advisory, with- 8 - out administration or executive powers. It must visit as a whole, or by a committee or by its secretary, all state, county, municipal and private charitable and correctional institutions at least once a year, but the hospitals for the insane must be visited as often as once in six months and by at least two members of the board. The board appoints an executive secretary and an assistant, and Laws of I 9 l6 - their salaries are fixed by the legislature. Every superintendent of a hospital must make a quarterly report SU PP- P- w- to the board in such form as it may prescribe, and also to the auditor of public accounts, regarding financial matters. The Laws of IJ)l6 - board must collect and publish statistics in regard to the defective classes both in and out of institutions and make an annual report SU PP- P- 7 7 - to the governor. b. Institutional. Each of the hospitals for the insane has a special f*^ r g f board of directors consisting of three members, appointed by the 00 ^ governor for terms of six years. The directors of the special boards 1662. constitute a general board of directors for all the hospitals. The ex-officio chairman of the general and special boards of directors is the commissioner of hospitals, appointed by the governor for four years. The members of the boards receive no compensation. The LW of 1916. commissioner receives a salary of $2,500 a year and $500 for trav- eling expenses. The commissioner is responsible for the proper disbursement all moneys appropriated or received for the maintenance of the J^" 1 * 1 hospitals. He must be a skilled accountant and is required to es- l66 4- tablish at all the hospitals a uniform system of keeping records and accounts, and to make annually to the governor a complete record of the business affairs of each hospital, with estimates of moneys needed, and recommendations for the improvement of the hospitals and their management. VIRGINIA 248 Each special board of directors is required to hold twelve regular meetings at the respective hospitals during the year. The general board of directors during each year holds one regular meeting at each hospital for the insane. The general board of directors, con- stituted for the control and management of all the state hospitals, Superintend- appoints for each hospital for a term of four years a superintendent who must be a skilled physician, and who is removable by the board for cause. The special board of each hospital, subject to the ap- proval of the general board, appoints for terms of four years other resident officers. Each special board is required to make an annual report to the governor in regard to the hospital under its manage- ment. The superintendent of each hospital appoints ill employees and some resident officers, may remove them and fixes their com- pensation, subject to the approval of his special board. 2. CARE a. In state institutions. Eastern State Hospital, Williamsburg; established 1768; 755 beds. Western State Hospital, Staunton; established 1828; 1,200 beds. Central State Hospital, Petersburg; established 1869; 1,800 beds (for negro insane). Southwestern State Hospital, Marion; established 1887; 720 beds. b. In local institutions. Insane persons who can not be received into the state hospitals may be provided for in the county poor- houses, which are under the management of the boards of county supervisors. The overseers of the poor of each county or the council of a town are charged with the relief of the' poor, including the insane. (All insane are now provided for in the state hospitals.) Admission of pay patients. 1677. 1678. 3. COMMITMENT a. Persons committed. All legal residents of the state, who are insane, not idiots, are entitled to admission to the hospitals for the insane. The examining board may receive any person for whom applica- tion is made for admission to a hospital if the person making it executes an obligation, with sufficient surety for the payment of the cost of maintenance and care of the insane person and other neces- sary expenses. But no non-resident insane person may be admitted or retained in any hospital under any contract with the board ex- cept when there is a vacancy not applied for on behalf of a resident of the state. A non-resident pay patient may at any time be dis- charged by the board, which must do so if it is necessary in order to make room for a resident of the state. 249 VIRGINIA b. Legal procedure in commitment. Any county or corporation C 1 g 1 9 aint - judge, or any justice of peace, who suspects any person in his county or corporation to be insane, or upon the written complaint or in- formation of any respectable citizen, must order the presence of such person, and summon two licensed and reputable physicians Summons, (one of whom must, when practicable, be the physician of the sus- pected person, but neither may in any manner be related to him or have an interest in his estate). The judge or justice and the two physicians constitute a commission to inquire whether the person is insane and a suitable subject for treatment in a hospital for the insane, and for that purpose must summon witnesses. The phy- sicians must, in the presence of the judge or justice (if practicable) , Examination, by personal examination and by inquiry satisfy themselves and the judge or the justice as to the mental condition of the person ex- amined. If the two physicians do not agree a third is to be sum- moned. The report of the commission must consist of a statement with questions and answers prescribed by the law, and of any further information bearing on the insanity of the person being examined. The record of proceedings together with the warrant of commitment must be made in duplicate, one copy to be delivered to the sheriff or sergeant of the county or city, and the other to be filed in the office of the county. If the commission decides that the person be Commitment. insane and ought to be confined in a hospital, and ascertains that he * is a citizen of the state, the judge or justice may order him confined in jail for a period not exceeding six days, pending conveyance to a hospital for the insane, or may commit him to the custody of some responsible person, who must furnish security for his proper safe- keeping without cost to the commonwealth until he is taken to the hospital or discharged from custody. The sheriff or sergeant to whose custody an insane person has ^ iSlifne 1 been committed, must on the same day the person is adjudged m ~ j^mmitment sane make application for admission to the nearest appropriate l672 - hospital, unless instructed otherwise by the commissioner of hospitals transmitting with the application a copy of the record or proceedings before the commission. As soon as the record of proceedings before the commission of insanity is filed in the office of the county clerk or clerk of the county court, the clerk must at once notify the commis- sioner of state hospitals for the insane, giving the name, age, sex and color of the insane person, the date of the finding of the com- mission, and the custody to which he was committed. If the in- sane person has been committed to jail, and remains there after six days from the date of the finding of the commission, the clerk must notify the commissioner of state hospitals. If the superintendent of a hospital fails to send for any insane person confined in jail within VIRGINIA 250 Examination at hospital of persons adjudged insane. 1674- Disposition of non-resident insane. 1676. Appointment of guardian. 1697. Laws of 1911 ch. 1 68. Code. 1698. 1699- Laws of 1916. s tc I tu o Ul six days after his commitment thereto, the commissioner of state hospitals for the insane must order the sheriff or sergeant in whose custody the insane person is to convey him to some hospital. A person admitted to a hospital as insane must be detained until the superintendent and his assistant have ample opportunity to observe and examine him. If they are of the opinion that he is not insane, he must, unless he be charged with or convicted of crime, be returned by the hospital authorities to the county or city from which he was committed, with a certificate of discharge. If a commission in insanity finds the person examined by it insane and a non-resident of the state, the same proceedings are to be had as if he were a resident. A statement of the fact of his non- residence and place of domicile, must accompany any order re- specting him; and the superintendent, if the person is sent to a hospital, or the court to whose jail he may have been committed, must have him returned to his friends, if known, or the proper authorities of the state or county from which he came if practicable. If a person be found to be insane by a judge or justice of the peace, or in a court in which he is charged with crime, the court of the county or corporation in which he is an inhabitant must appoint a committee for him. If a resident of the state is suspected of being insane, but has not been so found, the court of his county or corporation must upon proper application examine his state of mind and appoint a com- mittee of his person if he is found insane. A similar procedure except as to examination is prescribed in the case of a non-resident who is suspected of being insane and who has property in the state. c. Voluntary admission. A legal resident of the state in the early stages of insanity whose mental condition is such as to render him competent to make application or whose application if he is not of the age of twenty-one years is made by parent or guardian, may be received by the superintendent of a state hospital as a voluntary patient provided that his mental derangement is not the temporary effect of alcohol or any drug and provided that his admission does not deprive any committed patient of treatment in the hospital. Such a patient may be detained not more than ten days after giving notice of his intention to leave or after notice has been given by another for him. Every voluntary patient is required to defray his own expenses except that the board of directors of the hospital may exempt him for payments for two months if they consider him financially unable to defray his expenses. s 251 VIRGINIA d. Appeal from commitment. Any person held as insane may by Jgj as corpus - means of a writ of habeas corpus have the question of the legality l6 ?s- of his detention and of his sanity determined by a court of competent jurisdiction. If he is in custody, he may file his objection in the circuit court of the county or city in which he resides, or in which he was adjudged insane, and after notice to the authorities of the hospital or to the person claiming the right to the custody of such person, the court must determine whether the person is sane or insane. e. Cost of commitment. All expenses incurred in committing l671 ' a patient to any state hospital are to be borne by the county or corporation from which he is sent. 4. CONVEYING PATIENTS TO THE HOSPITAL The superintendent of a hospital must forthwith send an attend- **&/*: ant from the hospital to conduct the insane person for whom applica- tion for admission has been made. Or the superintendent may appoint some other suitable person for the purpose or may order the sheriff or sergeant of the county or city to convey him to the hospital. The cost of conveying insane persons to the hospital is paid from the funds appropriated for this purpose by the state. The cost of transportation of a voluntary patient is not borne by the hospital. Laws of I9l6< 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS The superintendent of a hospital must in suitable cases grant tendent superin ~ furloughs to insane patients for such time as, in his judgment, may Co x d ^g 8 benefit them; but all costs of removal for furloughs must be paid by the patients or friends, if able to do so. When an insane person confined in a hospital or jail is restored to l688 - sanity, the superintendent or the court must discharge him and give him a certificate of discharge. Except in the case of a person charged with crime or convicted of P^ r ^ e r f sons crime, the superintendent of any hospital or the court of any county ^ *^ r or corporation, may deliver an insane person to a friend who will give I68 3- bond with surety for his maintenance. When an insane person, except as aforesaid, is deemed by the superintendent both -harmless and incurable, he may deliver him without bond to any friend who is willing and able to take care of him without cost to the common- wealth. If a friend into whose charge an insane person has been l684 - given delivers him to the sheriff of the county or sergeant of the corporation, according to the condition of the bond, the latter must bring the insane person before a judge or justice of his county or corporation for a re-examination. VIRGINIA 252 7. COST OF MAINTENANCE state by the ^ ne ex P enses f removing and supporting insane persons are 1680. paid out of the state treasury upon the order of the commissioner of Recovery. hospitals. But when the insane persons have sufficient estate and have no husband, wife, child or kin dependent on them, it must be applied to such expenses. 1691. The commission or court ordering an insane person to be con- fined in a hospital must cause a certificate of his estate, or, if the person be a married woman or infant, who is not an orphan, of the estate of the husband and any separate estate of the wife, or estate of the parent, and also of the probable annual profits of such estate, to be sent to the directors of the hospital, and to the next court or corporation of which the insane person is an inhabitant. 8. CRIMINAL INSANE If any person charged with crime is found by the court to be insane anc * tne court orders him committed to the department for the C i6&2 criminal insane at one of the state hospitals he must be kept there until restored to sanity. If prior to the time of trial the court or the attorney for the commonwealth believes that such person requires care and observation in such a hospital the court may appoint one or more experts in insanity or other qualified physicians not exceeding three to examine him and may commit him to the department for criminal insane. A copy of the complaint or indictment and the medical report must be delivered with the patient to the superin- tendent of the hospital. wn S e P n S restored When the superintendent considers such a patient not insane or to sanity. restored to sanity he must be returned to jail. Any person after conviction of crime or while serving sentence in any penal institution or reformatory, if declared insane by jury must be committed to the department for the criminal insane at the proper state hospital and kept there until restored to sanity. Temporary f n case an order of commitment is made as provided in any of the confinement , > r institution preceding paragraphs the sheriff must immediately ascertain whether a vacancy exists at the proper hospital in the department for the criminal insane. Until there is a vacancy the insane person shall be kept in the county jail, penitentiary, reformatory or in such custody as the court may order. 253 WASHINGTON Authorities: Remington's Codes and Statutes of Washington, 1916 Laws of 1915, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control consists of three citizens Board of control. of the state, no more than two of whom may belong to the dominant ^-^ political party, appointed by the governor for six years, and remov- able at his discretion. Each member of the board receives a salary of $3,000 per annum, and necessary expenses. The board has power to make all repairs and improvements that, 50 *4- in its judgment, may be necessary for the conduct of the hospitals under their charge. It takes charge of the general interests of the hospitals, supervises the transportation of patients, employs super- intendents; and may prescribe the duties of all persons connected in any way with the management of the hospitals. The board of control is required to arrange with the United States La ^ s of IOIS - Bureau of Immigration for deportation of the alien insane. b. Institutional. The superintendent must be a skillful practicing superintendent, physician, and holds his office for such time as the state board of s ^ 6 - control may deem wise. He has entire control of the treatment of the patients and of all other internal government and economy of the institution, appoints all subordinate officers and employees and has entire direction of them. 2. CARE a. In state institutions. Western State Hospital, Fort Steilacoom; established 1870; 1,466 beds. Eastern Hospital for the Insane, Medical Lake; established 1889; 1,100 beds (also criminal insane). Northern State Hospital for the Insane, Sedro Woolley; established 1909; 700 beds. b. In local institutions. The indigent insane who can not be admitted to the state hospitals must be cared for by their respective boards of county commissioners (except in certain incorporated cities with a special poor department) and may be provided for in the county almshouse. 3. COMMITMENT a. Persons committed. All insane persons, having a legal 5959. residence in the state, not idiots, imbeciles, harmless chronic dements or cases of acute mania a potu, have the right of admission to the WASHINGTON 254 3960. state hospitals. Non-residents who come into the state while in- sane may be committed for temporary care, as in the case of persons becoming insane while traveling in the state, or of sailors becoming insane upon the high seas. Application. b. Legal procedure in commitment. The superior court of any county, upon the application of any one under oath alleging that any person by reason of insanity is unsafe to be at large, must have such person before him, and summon witnesses and two reputable physi- cians before whom the judge must examine the charge, unless the accused or any one in his behalf demands that the question of in- sanity 'be decided by a jury. If no jury is demanded, and the physi- cians certify under oath that the person examined is insane, and the case is of a recent or curable character, or that the insane person is of a homicidal, suicidal or incendiary disposition, or that he would be dangerous to his own life, or the lives and property of the com- munity in which he may live, the judge must commit him to one of the hospitals for the insane if he believe that the proper facts of insanity have been established. Smfnton f ^ ** * s necessarv ^ or want of room, or other cause, to discriminate ^ven 10111 m ^ e general reception of patients, a selection may be made in the 5964- folio wing order: (1) recent cases, when the disease is of less than one year's duration; (2) chronic cases, of more than one year's dura- tion, presenting the most favorable prospects of recovery; (3) those for whom application has been longest on file, other things being equal. Where cases are equally meritorious in all other respects, the indigent must be given the preference. 5969. The relatives or friends of any person charged with insanity in all cases have the right to take charge of and keep him if they desire so to do; but the superior judge may require them to give a bond for his safe-keeping. commitment Any P erson charged with insanity but not insane beyond all Laws^of 1915. reasonable doubt may be committed by any judge of the superior court to the detention ward of a county hospital or other suitable place of detention for a period of thirty days. During this time the patient is under the observation of the county physician who may obtain an extension of the time of observation for not more than another thirty days. c. Voluntary admission. Habeas corpus, (j. Appeal from commitment. Writs of habeas corpus may be !o6o" granted for the protection of insane persons by the supreme court or superior court or by any judge'of either court, and upon application the writ must be granted without delay. 5956. e. Cost of commitment. When a person is found to be insane, the costs of commitment must be paid by the county; but when the 255 WASHINGTON insane person is a resident of another county, the county in which proceedings were had may recover all costs and expenses from the county of which the insane person is a resident. 4. CONVEYING PATIENTS TO THE HOSPITAL When ordering an insane person sent to a hospital for the insane, 5954. the superior court judge must direct the sheriff to notify the superin- tendent of the hospital, and transmit a copy of the complaint and commitment and physician's certificate, which must always be in the form as furnished to the courts by the board of control. The state board of control has charge and supervision of the^r^of transportation of insane persons to the hospitals for the insane and supervises, is vested with authority to employ necessary persons for such pur- pose. 5. TRANSFER OF PATIENTS Upon recommendation of the superintendent the state board of g^" f j- control may transfer a patient to another hospital. A certificate of 5966. the fact and the reasons therefor must be transmitted to the clerk of the committing court and the kin or friend of the patient. 6. PAROLE AND DISCHARGE OF PATIENTS Any patient so far recovered as to make it safe for him and the f/ n dent superin " public to allow him to be at large may be paroled by the superin- Laws^of i 9 i 5 . tendent and any patient becoming sane and probably free from the danger of relapse must be discharged. Indigent patients, when discharged, may be returned to the county from which admitted, at its expense. The superintendent must officially notify the R - c - 6g proper superior judge, relatives or friends of the discharge or death of any patient, and give the date and reasons for such discharge or death. Each indigent patient discharged must be furnished with suitable clothing and a sum of money not exceeding $10. Upon presentation of evidence that friends or relatives will be R j J^" 1 t ^ >f able to provide proper care for an insane patient, the superior court judge issuing the commitment may order his removal from the hospital to the custody of such relations or friends. If it is brought to the knowledge of the judge that the patient thus removed is not cared for properly, or is dangerous to persons or property, he may order him returned to the hospital. 7. COST OF MAINTENANCE All patients in the state hospitals are supported by the state, and payment therefore is exacted from no one. Nor may donations be accepted by the hospitals with the understanding that they are in payment for the keep of any patient, although gifts may be received for the general support of the hospitals. WASHINGTON 256 Commitment by the court. Trial by jury. 5979- Discharge of criminals. 5975- S976. 8. CRIMINAL INSANE The superior courts of the state have power to commit to the hospital for the insane any person who upon being arraigned for an indictable offense is found by the jury to be insane. The prosecuting attorney of any county wherein a person may have been acquitted of a crime because of insanity may have him brought before the superior court of that county for trial by jury as to the question of his sanity. If the jury finds that the defendant committed a crime, that he was acquitted because of insanity, and that he is insane and unsafe to be at large, he must be committed to the department for criminal insane. Either party may appeal to the supreme court as in other cases. When any person committed as criminal insane claims to have recovered, he may apply to the physician in charge of the criminal insane for an examination. If the physician certifies to the warden that there is reasonable cause to believe that such person has become sane since his commitment and is a safe person to be at large, the warden must send him to prison and petition to the court that committed him, to discharge him. The prosecuting attorney of the county must resist the application at a trial by jury. Either party may appeal to the supreme court from the judgment discharging the petitioner or remitting him to custody. If the petitioner sub- sequently claims to have become a sane person, he may upon a certificate of probable cause by the attending physician again petition for discharge, under the same proceedings When a criminally insane person who has been discharged again becomes insane, the prosecuting attorney of the county from which he was committed may petition for his recommitment and trial by jury in regard to his mental condition. Any person committed to the department for criminal insane must not be discharged from the custody of the warden except upon the order of a court of competent jurisdiction made after a trial and judgment of discharge. 257 WEST VIRGINIA Authorities : Code of West Virginia, 1913 Laws of 1915 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control is composed of three JJJJgJj ' members chosen from the two largest political parties, not more than J* z of two of whom may belong to the dominant party, and appointed by * the governor for terms of six years. Each member of the board receives a salary of $5,000 a year and is obliged to give his entire time to the public institutions under its control. The board has full power to manage, direct, control and govern Co ^ e the hospitals for the insane, but the appointment of superintendents $95. is vested in the governor. The board has the power to recommend to the governor the removal of any superintendent and fixes the number of all subordinates and their compensation. The governor and state board each have authority to cause an expert inspection or investigation. The board reports biennially to the governor. The state board must take steps to cause the deportation of any alien in the state hospitals and the return of a non-resident to his own state. Biennally a joint committee of the legislature must investigate the 3371. condition of the hospitals for the insane and report upon it. The state board has authority to issue permits for the establish- P te i ment of private hospitals for the insane, to investigate and inspect z8 - them, and revoke the permits after reasonable notice. b. Institutional. There are no local boards of trustees. The 3331. superintendent and his medical assistants must be physicians and graduates from reputable medical colleges. 2. CARE a. In state institutions. Weston State Hospital, Weston; established 1858; 1,050 beds. Spencer State Hospital, Spencer; established 1893; 600 beds. Huntington State Hospital, Huntington; established 1897; 650 beds. b. In local institutions. An overseer of the poor is appointed by the county court for each magisterial district and is responsible for the care of indigent persons who are not provided for in public in- stitutions. Every county court may establish a county infirmary to which homeless indigent insane are admitted on the order of the overseer of the poor or the county court. The sheriff is permitted 3337 WEST VIRGINIA 258 Complaint. 3382. Hearing. Commitment. 3383. Examination at hospital. to hold in the county jail a violent insane person provided that admission to a state hospital is refused. 3. COMMITMENT a. Persons committed. All persons who are residents of the state and have a legal settlement in any county are entitled to care and treatment in one of the state hospitals for the insane. Non- residents may, however, be admitted under contract with the board of control if there is a vacancy in any hospital. A non-resident so admitted may be discharged at any time to make room. b. Legal procedure in commitment. Any resident of a county may complain to the clerk of the county court of any person sus- pected of being insane. The clerk must then issue a warrant on which the person is brought before the county commission of lunacy, composed of the president and clerk of the county court and the prosecuting attorney. They meet at the county seat unless it appears advisable to meet at or near the residence of the insane person. The commission appoints a guardian ad litem to manage the case of the suspected person. Among the witnesses must be two physi- cians who must separately make a physical and mental examination of the patient and make out a verified certificate of their findings. If the commission decides that the person is insane, and ought to be confined in a hospital and ascertains that he is a citizen of the state, then, unless some person (to whom the commission in its discretion may deliver him) will give bond with sufficient surety to restrain and take proper care of him until he recovers, or he is delivered to the sheriff of the county, to be proceeded with according to law, the commission must order him to be removed to the nearest hospital. The interrogatories to the witnesses and the answers must be in writing, and, together with a written statement by the commission to the fact of insanity, must be transmitted with the order of commitment. Pending a vacancy at one of the hospitals, and until the superintendent removes him, the patient is delivered to the custody of the sheriff or some relative or friend and may not be confined in any jail or lockup unless his condition is violent or dangerous. It is the duty of the superintendent of whom inquiry has been made to cause the removal of the patient to the proper hospital without delay. Soon after the patient arrives at the hospital an examining board (the superintendent and assistant physicians) must be convened, and if they concur in opinion with the commission, must register him as a patient. If the examining board rejects the patient because in their opinion he is not insane the superintendent must return him by an attendant to the sheriff of the county, where- 259 WEST VIRGINIA upon the commission of lunacy must promptly reconsider and dispose of the case. If the commission find that the person suspected is insane but a 3341. resident of another county it transmits the evidence to the sheriff who delivers the patient to his county of residence and proceedings are there taken for his commitment. If some relative or friend will care for the patient the commission ^.ktjve may may take a bond of $500 with condition that the insane person be"" ** 6 - restrained and properly cared for till the cause of confinement ceases or the patient is again delivered to the commission. If the person is found tj be harmless and incurable he may be delivered to any relative or to a friend without bond. When any person is confined in any jail as insane, the jailer must certify the fact to the circuit court of the county at the next ensuing term. The court must cause him to be examined by two competent msa ^ physicians and make such provision for his maintenance and care as his situation may require. The allowance to the jailer shall not exceed one dollar a day except 3356. in extraordinary cases and the jailer must apply once in ten days to a state hospital for the admission of a patient if the application is refused for the want of room. If a person residing in this state is suspected to be insane, the circuit court of the county of which he is Guardianship, an inhabitant, must on the application of any person interested and after five days' notice to the person so suspected proceed to examine into his state of mind, and, being satisfied that he is insane, appoint a committee for him. The same procedure is provided for in the case of a person residing out of the state, but having property therein, who is suspected of being insane. c. Voluntary admission Any resident of the state in the early 3382. stages of insanity or believing himself about to become insane or believing that treatment in one of the state hospitals would be beneficial to him shall be received as a voluntary patient on a verified written application to the state board which may require the cer- tificate of one or more physicians or other evidence. A voluntary patient may leave the hospital on five days' notice if in the judgment of the superintendent he is in fit condition and may be discharged upon the certificate of the superintendent because cured or because further treatment is unnecessary. d. Appeal from commitment. The writ of habeas corpus must H b s e 3 s <*nms. be granted by the circuit court to a person who by himself or by some one in his behalf applies by petition, showing evidence that he is detained without lawful authority, or is wrongfully denied a certif- icate of restoration. The superintendent shall have five days' notice of the trial and shall be represented by the attorney general. In WEST VIRGINIA 260 Hospital attendant. 3335- By the board. 3373. Upon recovery. 3350. Applications. 3349- case the court finds the patient sane he shall receive a certified copy of the order made by the court. e. Cost of commitment. All expenses are paid out of the county treasury. 4. CONVEYING PATIENTS TO THE HOSPITAL The superintendent must be notified immediately by the clerk of the county court of any commitment and if he considers the patient a proper one for admission and has room for him he sends an at- tendant at the expense of the hospital. If there is no room the superintendent notifies the board of control which may cause the patient to be sent to another state hospital. Any relative or friend of the insane person may be allowed by the county commission of lunacy to deliver him to the hospital without expense to the county or state. 5. TRANSFER OF PATIENTS The board of control has authority to transfer patients from any institution under its management to any other institution of like nature. 6. PAROLE AND DISCHARGE OF PATIENTS When any patient in the state hospital is restored to sanity the superintendent gives him a certificate of restoration and discharges him. Any patient on parole or otherwise temporarily released may present himself to the superintendent for examination and discharge. Except in the case of a person charged with or convicted of crime or confined in a state hospital or a private licensed hospital the com- mission of lunacy must make an inquest on application for discharge of any person confined as insane and set him at liberty if they have authority to do so and find him restored to sanity. The guardian or committee is entitled to the custody of a patient when he is not confined in a state hospital or jail. The board of control may prescribe regulations regarding parole and discharge of patients. 7. COST OF MAINTENANCE The expense of the maintenance and care of any insane person confined in a hospital must be paid out of the treasury of the hospital; and, if he is kept in jail the expense of maintenance and care must be paid out of the public treasury. Any payments made from the county treasury may be recovered from the estate of the patient or his guardian, father, mother, husband, wife or child. 261 WEST VIRGINIA 8. CRIMINAL INSANE If any person charged with or convicted of crime is found to be- on . " insane, the court must order him to be confined in one of the hospitals for the insane as soon as there is a vacancy. When such a person 3345. is restored to sanity, the board must give notice thereof to the clerk 3349- of the court by whose order he was confined, and deliver him in obedience to the proper precept. If a person is found to be insane by the justice before whom he may be examined, or in a court in which he may be charged with crime, the circuit court of the county of which he is an inhabitant, must appoint a committee for him. If a convict in a penitentiary becomes hopelessly insane, a justice insane convicts. must be notified and if satisfied that the convict is insane and ought to be confined, must order him committed to a hospital for the in- sane, unless some person will give bond to restrain and take proper care of him until the cause ceases or the patient is delivered to the sheriff of the county. In case of recovery, the board of directors of the hospital must notify the clerk of the court by order of which patient was confined in the hospital. 262 WISCONSIN Board of control. Statutes. 56ia. 2.0.17 56i. 56ie. 564. Visiting committee. 5620. Officers. S6ij. County asylums. 6043. 6o 4 h. Authorities: Wisconsin Statutes, 1915 Laws of Wisconsin, 1917 i. ADMINISTRATION AND SUPERVISION a. General. The state board of control is composed of five mem- bers, one of whom must be a woman, appointed by the governor for terms of five years. The president receives $3,600 per annum, the other members $2,500 each per annum. The board has the entire management of all the state institutions. It is required to inspect each hospital at least once a month. The board acts as a commis- sion in lunacy, with power to examine any person committed to any public or private hospital for the insane or who is restrained of his liberty by reason of alleged insanity at any place, and may order the discharge of any person who is not insane, except one held for trial on a criminal charge or confined by a court in a criminal proceed- ing. The board must each year file with the secretary of state a statement giving the name of every inmate in either of the state hospitals for whose support in whole or in part any county is legally chargeable, the length of time for which support is charged, and the amount due the hospital for the support of such inmate from a county. The board of control also has the duty of inspecting each county asylum at least once in three months, supervising and control- ling the care of their patients, and examining plans and specifications for such asylums. The governor must annually appoint a visiting committee of three, one from the members of the senate and two from the members of the assembly, to visit the state hospitals and report in writing to the governor. b. Institutional. The board of control appoints for each hospital a superintendent, a matron and a steward. It fixes the number of subordinate officers and may remove any officer and employee for cause. All staple supplies for the state hospitals are purchased by the board which also passes monthly in advance on all estimates for expenditures, and plans and supervises all improvements. Each county asylum for the care of the chronic insane is governed by a board of three trustees elected by the county board for terms of three years. The trustees are required to meet at least once in three months and to make an annual report to the county clerk. In any county maintaining both a poorhouse and a county asylum for the insane, the trustees of the latter are ex-officio superintendents of the poor, unless the county board orders otherwise. The board 263 WISCONSIN of trustees appoints a visiting physician and a superintendent of the county asylum. All other officers are appointed by the superin- tendent, subject to the approval of the board of trustees. 2. CARE a. In state institutions. Wisconsin State Hospital for the Insane, Mendota; established 1860; 650 beds. Northern Hospital for the Insane, Winnebago; established 1873; 650 beds. Milwaukee County Hospital for Mental Diseases, Wauwatosa; es- tablished 1880; 559 beds. (A semi-state institution.) Central State Hospital for the Insane, Waupun; established 1909; 100 beds. (For the criminal insane.) b. In local institutions. The chronic or incurable insane are pro- vided for in the county asylums, of which there are thirty-five in the state^ the largest is the Milwaukee county asylum at Wau- 603. watosa, with a capacity of 835 beds. Any county board may with the consent of the state board of control establish an asylum for the care of the chronic insane. Plans of buildings must be ^i. approved by the state board of control. Two or more counties may unite in maintaining an asylum. A county board may erect a hospital for insane patients who are 1421-17. affected by pulmonary tuberculosis in connection with a county asylum for the chronic insane, with the consent of the board of control. 3. COMMITMENT a. Persons committed. All insane residents of the state, not Pj^[j|!g tion o idiots, except those who are incurably insane, are entitled to ad- 584- mission to the state hospitals or if from Milwaukee county to the hospital of that county. Chronic insane are admitted to the county asylums for this class. Patients are admitted to the state hospitals from the several 583. counties in the ratio of population, but each county is entitled to the admission of at least two if desired. An insane person whose resi- dence can not be ascertained must be received by the superintendent as a patient from the state at large, and not be charged to the county as one of the number to which it is entitled. But such person must be charged to the proper county when his residence is ascertained. b. Legal procedure in commitment. Application may be made in Application, behalf of a person supposed to be insane by any three respectable citizens to the judge of the county court for a judicial inquiry as to his mental condition and for an order of commitment to some hospi- WISCONSIN 264 5 8 s- 5 8sb. of n atient ent commitment tal or asylum for the insane. The judge must appoint two compe- tent and disinterested physicians to examine the person. They must be graduates of a legally incorporated medical school or licensed to practice medicine in the state, and must have had at least two years' practice or one year's experience as physicians in an insane hospital, and be registered by the county judge as qualified. Before making an examination, which may be held in the presence of the judge, the physicians must, if it seems expedient, notify the person to be examined that application has been made for an inquiry into his mental condition, but may withhold notice and the names of the applicants if it seems best, in which case they must state their reasons to the judge. The sworn report of the physicians must con- sist of answers to questions prescribed by law and are to be made in each case, whether the question of insanity is tried before a jury or otherwise, and must be forwarded with the commitment papers to the hospital superintendent. If the notice provided for was not given to the person supposed to be insane, the judge may Appoint a time and place for hearing the application, and must serve such notice. If notice is ordered, and no jury trial requested, the judge may proceed at the time and place specified in the notice, or if no notice is ordered then after receiving the report of the physicians, to make such further investigation of the case as may seem to him necessary. If satisfied that the person is insane, he may order his commitment to the hospital or asylum for the insane of the district to which the county belongs. If the judge thinks the interest of the person alleged to be insane requires it, he may appoint a guardian ad litem, the expenses to be paid by the county in which the proceed- i n g s were held. If demanded by the person alleged to be insane or byany one acting in his behalf before or after commitment, the judge must summon a jury to try the case in the presence of the person supposed to be insane and his counsel and immediate friends and the medical witnesses. All other persons are excluded. If the jury or judge find that the person alleged to be insane is a fit subject to be sent to a hospital or asylum, the judge must order him committed to either state hospital. If he is a resident of a county having an asylum for the chronic insane, and the judge is satisfied that the insanity of the person has become chronic, he may commit him to such asylum. ^ district court in any county, which is a court of record, has the same powers in respect to examination of persons alleged to be insane and their commitment as the county courts. ^ n rece ipt f an application for the commitment of a person alleged * ^ e insane or the report of physicians, the judge may require the sheriff to confine him in some specified place until further proceed- 265 WISCONSIN ings can be had. The judge may also order the detention of any person whose sanity is being investigated for proper medical observa- tion. But no person may be confined in a jail or other prison for confinement of criminals or any poorhouse, unless it appears to the judge that such confinement is essential to the safety of the person or that of the public, and the period of confinement must not exceed ten days, unless otherwise ordered by the judge. The county board of any county is authorized to provide suitable buildings for the pur- pose of temporary detention of the alleged insane. c. Voluntary admission. A person who may be insane or suf- Application, fering from mental disorder, may, upon his written application stating his mental condition, supported by the certificate of at least two physicians possessing the qualifications prescribed by law, based upon personal examination of him, be admitted as a voluntary patient to any public hospital for the insane, in the discretion of the superintendent. A person, so admitted to either of the state hos- pitals, if not indigent, must pay such sum for his maintenance as the state board of control may direct, and no charge for his maintenance may be made against any county; if so admitted to any other public institution for the insane, if not indigent, the trustees thereof fix the compensation to be paid. Voluntary patients have the right to leave the hospital at any time if in the judgment of the superin- tendent they are in fit condition, on giving five days' notice of their desire to do so. d. Appeal from commitment. On his own verified petition or that I*-* 01 of his guardian or some relative or friend, a person adjudged insane 587. or detained as such, may have a re-trial or re-examination as to his sanity before the judge of the circuit court or county court or any other court of record in the county in which he resides or was ad- judged insane. The judge receiving the petition must order two qualified physicians (sec. 585) to examine him and report, fix the time and place of examination and give reasonable notice to the guardian of the person to be examined, and to the superintendent of the hospital or asylum in which he may be detained, all of whom may appear and offer testimony at the examination. If the physi- cians report the person insane, and the judge is satisfied with the correctness of it, and no demand for a jury trial is made, a judgment to that effect must be entered. If the case is tried by jury and the jury disagree, it must be discharged and another jury may be im- panelled. If the jury find the person sane, the judge must order his discharge, or, if insane, order him returned to the hospital or the asylum where he may be detained. Or if the person is on parole or leave of absence, he must be allowed to remain at large unless the judge is satisfied that it will be unsafe, in which case he may order WISCONSIN 266 his commitment to a hospital. In case no jury is demanded, the state board of control, acting as a commission in lunacy, may determine the sanity or insanity of a person committed to either of the state hospitals for the insane, whether he is an actual inmate thereof or at large on parole, or committed to any other hospital or asylum. Its determination has the same force as one made by a judge; or the board may, if it has reason to doubt the insanity of the person named, request the proper judge to make due inquiry. The foregoing provisions do not apply to any person awaiting trial on a charge of crime who is committed to any asylum or sentenced to confinement in the state prison or state reformatory, who has been lawfully adjudged insane and been transferred to either of those institutions or to any asylum, until the expiration of the term for which he was sentenced to imprisonment. Ha 595* s corpus> All persons confined in either state hospital, except those charged with or convicted of crime, are entitled to the benefit of the writ of habeas corpus, and the question of insanity must be determined by the court or judge issuing it. The decision that the person is insane is no bar to the issuance of a writ a second time if it is claimed that the person has been restored to reason. s8sd< e. Cost of commitment. All expense of the proceedings, from the presentation of the application to the actual commitment or discharge of an insane person, whether he is a resident or non-resident of the county in which the proceedings are had, are paid by the county from which he is committed. If any county is chargeable with some portion of the expense of maintaining the person com- mitted, the county must pay the expense of the commitment. If the insane person is a resident of any other county in the state than the one from which he was committed, the county in which he resides must reimburse the county from which he was committed all expenses of the examination and commitment. 4. CONVEYING PATIENTS TO THE HOSPITAL Attendants. The warrant of the court to take a person to a hospital may be executed by a relative or friend of the patient if competent, other- wise by the sheriff. Every female over ten years of age must be accompanied by a competent female attendant. 5. TRANSFER OF PATIENTS 6o< * b - All inmates of the state institutions for the insane belonging to the county and held as chronic or incurable may be transferred to county asylums, as well as all other persons belonging to or residing in the county, who have been adjudged insane, and may be properly con- fined in such an asylum. Whenever any insane person committed 267 WISCONSIN to any asylum is found to be acutely insane, and to require per- manent or special treatment, he may be transferred to one of the state hospitals, and committed to it. The board of control may transfer patients from one hospital or By^ 6 board - asylum to another; and, if to the benefit of the patients in either of the state hospitals, may remove therefrom any chronic insane person not chargeable to any county to some county asylum. 6. PAROLE AND DISCHARGE OF PATIENTS The superintendents of the state hospitals and of the Milwaukee By th . * superintendent. county hospital may permit any inmate to go at large on parole, s87 - when in their opinion it is safe and proper to do so. If within two years it becomes unsafe to allow such person to remain at large any longer, the superintendent must require his return to the hospital, unless he has been adjudged sane by competent authority. At the expiration of two years, the presumption of insanity against such person ceases, and until a new adjudication to the contrary, it must be regarded as though his sanity had been established by a judicial examination. The superintendent of any county asylum may, upon the written recommendation of the visiting physician, permit any of its in- mates leave of absence for such time and under such conditions as he may direct. Incurable and harmless patients must be discharged whenever it is jjjjjjl^ * necessary to make room for recent or more hopeful cases, as may be 59. ordered by the state board of control. If the relatives or friends of any patient ask his discharge, except Bonj required, the criminal insane, before such person has recovered from in- sanity, the state board of control may require a bond, conditioned for his safe-keeping. 7. COST OF MAINTENANCE All insane persons residents of the state admitted to state hospitals P^ fc y the are maintained at the expense of the state ; but the county in which s88 - the patient resided before being brought to the hospital must pay for all necessary clothing and a fixed sum per week for the patient's support. Relatives, friends or guardians of a patient may pay for his maintenance and provide him with special care or special attendants upon payment in advance of the expenses. When 594- neither the state nor the county is properly accountable for the support of a patient in either hospital, the state board of control must ascertain the residence of the patient and secure his removal to it, if practicable; provided, it can be done at a cost not exceeding $100. WISCONSIN 268 Estate of insane person liable for his support. menTby'state Each county caring for its own chronic insane in an asylum is 6 4d. entitled to receive a stated sum per week for each person cared for. 6o4e. g u t n o county is entitled to any compensation for the care of any person who has not been adjudged insane and properly committed, nor for the care of any insane person whose support is not properly a public charge. 5*5- In no case may payment be made by the state toward the main- tenance of a patient in a county asylum until the expiration of five days after the state board of control has received copies of the commitment papers together with a certificate of the judge stating the reasons for sending such persons to the county asylum instead of to the hospital. The property and estate of any insane patient in a state hospital or county asylum, or kept by any county at its charge, and of a deceased patient of a hospital or asylum, are liable for his continuing 6 4 *' and past support and maintenance; and upon failure of the person having custody of such property or estate to pay for the support of the patient, the state board of control, the board of trustees of the asylum or the board of the county furnishing the patient's support may apply to the proper county judge to compel payment. 5848. When a person is brought before the county judge for examination for whose support, in whole or in part, any county may be chargeable, he must give due notice of the hearing to the district attorney of the county supposed to be chargeable and must take testimony showing the actual and legal residence of such person, his general financial ability, and in case the testimony does not disclose property sufficient to save the county from the expense of his support, then the general financial ability and residence of any person chargeable with his support. 8. CRIMINAL INSANE with The courts of record in the state may commit for safe- keeping or treatment to the hospitals for the insane any person charged with or convicted of any crime punishable by confinement in the state prison, and awaiting hearing, trial, conviction or sentence on ac- count of the alleged insanity at the time of the commission of such crime or at any time afterwards and prior to sentence. When any person is indicted or informed against for any offense and it is claimed before trial that he at the time of the commission of the offense was insane and not responsible for his acts, the court must order the question tried and determined by the jury. If the jury finds that the person was insane or that there was reasonable doubt of his sanity at the time of the commission of the alleged offense, they must return a verdict of not guilty because insane. 269 WISCONSIN The court must thereupon commit him to one of the state hospitals for the insane, to be detained and treated until he can be discharged according to law. A re-examination of his sanity may be had as in the case of other patients, but no person thus committed may be discharged unless the magistrate or the jury passing upon his sanity, in addition to finding him sane, also find that he is not likely to have such a recurrence of insanity as would result in acts which, but for insanity, would constitute crimes. The board of control, acting as a commission in lunacy, may ad- ^ sion judge any prisoner. in the state prison, in any county jail or in the St ^ t 6 u I ^ es - Milwaukee house of correction to be insane and may, with the approval of the governor remove him to the state hospital for the criminal insane. If a prisoner thus removed recovers his reason before the expiration of his sentence, he must, by order of the board, be returned to the prison from whence he was taken. 270 WYOMING Authority : Compiled Statutes of Wyoming, 1910 i. ADMINISTRATION AND SUPERVISION fharities f and a ' General. The state board of charities and reform is composed reform. o f the governor, the secretary of state, the state treasurer, the state ch.37. auditor and the state superintendent of public instruction. The board has general supervision and control of all state charitable, reformatory and penal institutions. One or more of the members must personally inspect all state institution buildings at least once every year. 439- The board directs the general management of the state institu- tions, is responsible for the proper disbursement of all funds ap- propriated for their maintenance, appoints all the officers and pre- scribes their duties and compensation. 446. The secretary of the board makes a biennial report to the governor, superintendent, b. Institutional. There is no local board of trustees. The super- intendent of the hospital for the insane, appointed by the state board and subject to removal by it, must be a graduate in medicine, and must keep a full account of all his doings, and of the operations of the institution, submitting a monthly report to the state board. He employs all necessary help needed at the hospital, subject to the approval of the state board. 2. CARE 448. a. In state institutions. Wyoming State Hospital for the Insane, Evanston; established 1889; 225 beds. 3. COMMITMENT 460. a. Persons committed. Residents of the state who become in- sane are entitled to admission to the state hospital. Insane persons who have not acquired a legal residence must be returned by the state board of charities and reform, with the consent of the governor, either before or after admission to the state hospital, to the place of their residence, at the expense of the county from which they were committed. 450. Patients, whose friends will pay for them, or who have property to pay their expenses, are admitted to the state hospital on terms prescribed by the state board. hea'An 11 for ^' Legal procedure in commitment. Upon verified petition in 451- prescribed form of any relative or friend or other person to the district court or a judge thereof, that a person is insane, or incom- 271 WYOMING petent to manage hie property, the court must notify the supposed insane or incompetent person of the time and place of hearing the case and require his presence. The determination of the insanity or incompetency of any person J ur y trial - is by a jury of six men and is conducted as a civil action. If the jury returns a verdict that the person tried is insane, the 457. county physician, or some reputable physician appointed by the court must furnish a lunacy statement in prescribed form, containing answers to the questions prescribed and must return it to the clerk of the district court, within three days after the finding of the jury in such proceedings. The jury, in addition to finding upon the question of the sanity 454- of a person, must find the value of his estate, if any, or whether he is a pauper. If he has estate, the judge, commissioner or clerk presiding over the proceedings must appoint a guardian to take charge of his estate in the manner provided in relation to guardian- ship. The committing judge must in addition to the order of commit- 460. ment and the statement in lunacy, issue a certificate showing the 461. name, age, sex, nativity, and occupation of the person committed and his place of residence. The clerk of the court must send a certified copy of the verdict and the physician's lunacy statement, together with the commitment warrant to the superintendent of the hospital at the time of commitment. If the insane person sent to the hospital is a pauper, the clerk of 463. the court must provide him with the necessary clothing at the county's expense. c. Voluntary admission. d. Appeal from commitment. Persons restrained of their liberty Ha 6 b ^ s cor P us - are entitled to the writ of habeas corpus, upon sworn petition to the 6 a supreme or district court, or by any judge of either of those courts. 6328. e. Cost of commitment. The expense of the proceedings to P^ tjy^ 6 determine the question of a person's insanity is a charge against his Arties not able, estate. If he has none, the expense is borne by the county in which the proceeding is had. If the jury declares the person to be sane, then the one making the complaint, except a county officer, must pay the expense of the proceeding. The state pays all expenses of returning recovered patients, and of 473. patients found not to be insane, to their respective homes or the county from which they were committed. 4. CONVEYING PATIENTS TO THE HOSPITAL The superintendent of the hospital for the insane when notified ^o^tai at- by the county clerk, must, under rules provided by the state board, 464. ' WYOMING 272 have the insane person conducted to the hospital at the expense of the state. 5. TRANSFER OF PATIENTS 6. PAROLE AND DISCHARGE OF PATIENTS 27. COST OF MAINTENANCE Fute bythe Insane poor persons are supported at the hospital by the state. 475. The guardian of an insane person admitted to the hospital must pay for his support out of the estate of such ward. 476. Appropriations out of the county treasury for the care of any insane person may be recovered from any person who is bound to provide for an insane person, if he has sufficient ability to pay. 8. CRIMINAL INSANE e s r e s d n or a co"n- ^he state board of charities and reform must provide for the care victed of crime. an( j custody of all persons declared insane after legal inquiry has been made who are accused of, or convicted of crime, at the state hospital, or at a private institution within or without the state. Hearing. When a person accused of or convicted of crime, who is confined in any penitentiary, county jail or other place of confinement, awaiting trial, or on sentence, is of unsound mind, the officer having him in charge must and any citizen of the state may, make com- plaint, and the question of the sanity of the person must be tried and determined as provided by law in the case of other persons of un- sound mind. 470. If found insane, such person must at once be taken to the place of treatment prescribed by the state board. 471. When a criminal insane person recovers his reason, he must be returned to the penitentiary, the county jail or other place of im- prisonment where he was previously confined, to serve out the re- maining term of imprisonment if any. MENTAL HYGIENE QUARTERLY MAGAZINE OF THE NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC. 50 UNION SQUARE, NEW YORK CITY EDITORIAL BOARD THOMAS W. SALMON, M.D. Medical Director, The National Committee for Mental Hygiene FBANKWOOD E. WILLIAMS, M.D. Associate Medical Director, The National Committee for Mental Hygiene GEORGE BLUMER, M.D. WALTER E. FERNALD, M.D. Dean of the Yale Medical School Superintendent, Massachusetts School for Feebleminded C. MACFIE CAMPBELL, M.D. AUGUST HOCH, M.D. Associate Professor of Psychiatry, Johns Hopkins University Former Director, Psychiatric Institute, N. Y. State Hospital STEPHEN P. DUGGAN, PH.D. STEWART PATON, M.D. Professor of Education, College of the City of New York Lecturer in Neuro-biology, Princeton University MENTAL HYGIENE aims to bring dependable information to everyone whose interest or whose work brings him into contact with mental problems. 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