The 1930 MTA also revolutionised the discharge system. Certified patients could and would still be claimed out by their families who believed that being surrounded by the patient’s own family would help them recover more quickly. A large number of patients were released under Section 79 against medical advice, but with the approval of the Visiting Committee and with the relative taking full responsibility for any consequences, including the financial ones when re-certification became necessary. Amongst those was patient 254 who was on several occasions removed by her mother. Such removals were much more common in the 1930s and 1940s than before. The reason for this increase is unclear, but it may be assumed that, inspired by the new treatments available, relatives started to experiment with the hospital. If hopes for cure were disappointed, they lost faith in the institution, removing the patient. In other cases the family seemed content with improvement rather than cure and, as soon as they observed or the patient reported a change for the better, they put pressure on the Medical Superintendent to release the patient. Correspondence with the Medical Superintendent also shows that some patients were simply needed at home. In other cases certified patients put pressure on their relatives to take them home. Surviving documents from the DCMH point to anecdotal evidence of families refusing to accept the patient back into their community after the Medical Superintendent declared them fit for discharge. Reasons for this include the fear of being unable to control the patient, work commitments, poor health of other family members as well as financial strain. If there was no convincing reason for the patient to remain in hospital, he or she would be referred to the Public Assistance Institution and readmission was likely.
Owing to the new legislation voluntary patients could take their own departure after giving 72 hours notice. This change certainly made hospitalisation more attractive to patients, as they had at least some control over their release. The opportunity to self-discharge entailed the risk that patients might leave the hospital too early and would require rehospitalisation later. Figures from the DCMH show that in the 1930s the duration of hospitalisation declined significantly, but the readmission rate increased. Patients left the hospital against advice for various reasons, but frequently disagreements with either staff or the hospital routine preceded the departure. Although the Medical Superintendent had the power of certifying patients who wanted to leave against advice, such action was hardly ever taken – possibly for fear of ruining the trust in voluntary hospitalisation. Rather than invoking legal action, the Medical Superintendent – often supported by the patient’s relatives – found himself engaged in lengthy negations of an unprecedented nature to persuade the patient to stay. On the other hand, the new Act provided the Medical Superintendent with a convenient opportunity to relieve himself of the responsibility of vouching for a patient’s behaviour after declaring them ‘recovered’. By regrading the patient’s status to voluntary he provided the patient with the freedom to decide about their departure. The regrading of certified patients became increasingly common in the DCMH in the late 1930s and early 1940s – including patients who had been in hospital for several years as certified patients – but was apparently less common elsewhere in Britain (Pearce, 2002).