HL Deb 07 November 1988 vol 501 cc487-94

3.28 p.m.

The Earl of Longford rose to ask Her Majesty's Government what steps they are taking to provide more effective treatment for mental offenders.

The noble Earl said: My Lords, as they used to say in old fashioned novels, "This is all so sudden!" I was told that this debate would begin at 5.30 p.m. and we are two hours ahead of time, but I suppose that one cannot complain about that. They say that in the House of Lords anything might happen at any moment. Therefore, without more ado I ask the Question standing in my name on the Order Paper.

I asked a similar Question —this one is rather better phrased—four years ago and received a fairly unsatisfactory reply. Incidentally I fully understand why the Deputy Leader of the House cannot be here to reply. He has been most courteous about the matter. It is not for me to say that I am relieved that he cannot be here because I am sure that his colleague will he equally hostile to my line when he comes to speak. However, I believe there is less pressure on me because the Deputy Leader cannot tackle me.

I should like to say at once that I believe that this is the most difficult question in the sphere of social services. That does not mean that we should shirk it: it means that we should tackle it. However, the fact that it is so difficult has been partly responsible for the result that our national response to this problem, quite irrespective of party, has been totally inadequate. I am not saying that the situation is better anywhere else, but this remains a subject of the utmost difficult and urgency.

We punish people when they break the law. We do not always send them to prison but we blame people when they break the law if they have done something criminally and morally wrong. That is a prerequisite of any civilised order: that 99 per cent. of people are held morally responsible for what they do, including breaking the law. However, when people are sick, we do not blame them: we treat them. We do the best we can for them. Mental offenders— and I use that very wide phrase which will enable everybody to speak from all sorts of different angles—are people who have broken the law and at the same time have been able to persuade us that they are suffering from some sort of mental affliction. I am putting that in the most general terms. Clearly this is a grey area, a borderline area or an overlapping area where people who were once criminals and who have broken the law are also mental cases.

There are some easy illustrations. Many years ago my wife and I had a real friend. She was a woman who lived in Oxford and whose husband had died. She went off her head, to use the old-fashioned phrase, and murdered a child who used to play with my children. We were very fond of the woman and of the child. She was so clearly off her head that she was judged to he unfit to plead and was rightly sent to Broadmoor. There she met a fellow patient. Your Lordships are no doubt aware that in Broadmoor, as in similar places, they are called patients, not prisoners. She married her fellow patient and after leaving Broadmoor they lived happily ever after. That was a clear case of a mental offender who was unfit to plead.

Conversely, there is the case of the Yorkshire Ripper. I have been into that case carefully. Psychiatrists for both the defence and prosecution were of the opinion that he was a mental case who should go to a hospital. However, the judge in his wisdom—he has been criticised by many people—put the case to the jury and as a result the Yorkshire Ripper went to prison. In prison it soon emerged that the psychiatrists were right and after three years he found himself in hospital. One will get such difficult cases.

There is another case which I have read about since preparing my notes. The papers on Friday reported a man who had committed an absolutely horrifying murder together with much sexual misbehaviour. The man has said that he never wants to be released, which is perhaps sensible. The judge recommended that he never should be released and quoted the overwhelming medical opinion in favour of not releasing the man. It would be difficult to say that that young man was not a mental offender. It was admitted that he was grossly disturbed in his youth. Therefore, his was a borderline case. I raise these cases to illustrate this difficult subject—but, as I said, that does not mean that we should shirk it.

To focus our attention. I cite one case of a man whom I have visited in various prisons for the best part of 20 years and three years in a special hospital. I have known him for a long time. He had committed horrifying crimes. At the time his eminent counsel could not find a psychiatrist who could help build a psychiatric defence. Therefore for the first few years he served his sentence in prison.

Later the Home Secretary and the Home Office looked most carefully into the case. The noble Lord, Lord Allen. knows this case extremely well. At any rate. the Home Office obtained the best possible psychiatric opinion and sought to get the man sent to Broadmoor. However, the Minister for Health— an eminent man, but I shall not mention his name because I have no need to drag it in—decided that it was not possible and that it would not be an appropriate use of the facilities at Broadmoor. Therefore, although the Home Office wanted him to go to Broadmoor he was left in prison.

That was in 1971. Between 1979 and 1981 he was examined by a Home Office psychiatrist who decided again that he should go to Broadmoor or some such special hospital. Again nothing happened, so for another four years he remained in prison. Finally in 1985 he was sent to what I call the northern equivalent of Broadmoor. I am not sure that the staff would be pleased with that description but it explains what I am talking about. It is known as Park Lane Special Hospital. He has been well looked after ever since. In all, he spent 20 years in prison, 14 of them after the Home Office had endeavoured get him transferred to the special hospital where he spent three years. That is an illustration of how things can go wrong, because no one can pretend that they went right. Heaven knows how many psychiatrists were involved in that case over the years and how many representations were made by do-gooders of one sort or another. That is the sort of problem we are dealing with.

Therefore, I ask myself and the House what went wrong. One could say that it was the fault of the Home Office Minister, the Minister for Health or other Ministers of one sort of another. In all those years we can assume that more than one party had been in power. Ministers might make mistakes and doctors might make mistakes, so perhaps the law should be altered. Perhaps more resources should be made available. I am certain that more resources should be made available for the special hospitals so that there is no possibility of arguing that there is a shortage of facilities. Whatever the explanation, clearly something went wrong and I believe that that is often the case.

What do I suggest? I start with the assumption that where medical opinion is in favour of a man being transferred from prison to a special hospital or some other kind of hospital—or one of the regional secure units about which the noble Lord, Lord Allen, will he speaking with his expert knowledge—that offender should have a prima .facie right to that treatment.

I have spoken to a leading person in the area we are debating. He is a doctor, but he says that one cannot leave it entirely to the doctors to say whether an offender should be transferred. Therefore we must bring in a new factor, because leaving such decisions to Ministers has proved to be unsatisfactory. I have had a great deal of consultation with well qualified people who have given both the medical and legal points of view, and I suggest that there should be a review tribunal analogous to the Mental Health Review Tribunals. When one has sufficient psychiatric opinion in favour of a man being transferred from prison to hospital, he should go before the tribunal, and if the tribunal recommends a transfer, he should be transferred.

I am merely seeking to open up discussion and by no means trying to close it, but if I had my way and that proposal were adopted, the offender would have a right to be transferred. That would mean that the Home Secretary would have a duty to transfer him and the Minister for Health, or whoever was in charge of the health service at the time, would have a duty to find accommodation for him.

One aspect of that of course is that more resources might need to be made available to the special hospitals or to the mental health service generally. We are told that tremendous resources are being put into the expansion of the prisons. In that case, if my suggestion involves the expansion of the special hospitals, that expansion should take place. That is the proposal I lay before the House. I hope that the Minister, whether the Deputy Leader or his substitute, will consider it. I hope it will not be shot down without further reflection. I believe that my proposal commands a considerable amount of support. Clearly there needs to be much working out of the detail, as it could not automatically be put into operation.

I must ask the Minister to tell the House how many people in his opinion are in prison who could be suitably transferred to special hospitals or other mental hospitals. I asked that question four years ago and received an answer that, I have to say, made me smile. I hope that the Minister will riot be upset if I say that I am likely to view with scepticism any answer that he gives today. I hope when he does answer that he will explain how he has arrived at his answer. I read in a newspaper today that the Russian authorities now calculate that there are 11 political prisoners in Russia. Many people thought that there were—

Lord Renton

I beg your Lordship's pardon. Last week they said there were 25.

The Earl of Longford

There were 25 last week; there are 11 this week. That raises a kind of hollow laugh. It seems to be a pretty sick joke. The question is whether there are many thousands or hundreds of thousands. At any rate, the idea that there are only 11 political prisoners is ludicrous. When the figures are available from the Minister he will receive if not a hollow laugh—a kind of suppressed smile if he tells us that there are just a handful of mentally disordered people in this category. I am bound to press the Minister on the point of how he arrives at his figures.

I have referred to the man who was put in prison for 20 years. All the time that he was there I doubt whether he entered into any calculation of the people the Minister would have said were suitable for transfer. I shall want to know how the Minister arrives at his figures. I have ventilated the subject: I hope that others will follow it up.

There is another aspect of the matter which some people may consider runs in the opposite direction, but I am sure that those who follow me closely—in spite of my being rather hoarse—will not find any contradiction. It is argued by well-informed bodies like MIND and the Matthew Trust founded by that splendid pioneer in the field of mental health, Peter Thompson, and other bodies that have also given evidence to me, that some people are being sent to mental hospitals who should not be there. I must lay the thoughts of these bodies before the House. It is argued that at the end of their sentence some prisoners are sent to mental hospitals in order to prevent their coming out and that they are left to moulder there.

I press that matter upon the Minister. Although it does not come under my direct first-hand scrutiny, it is a situation felt quite strongly by the bodies I have mentioned. I have been asked to put a question to the Minister. What information can be given about the number of prisoners transferred towards the end of their sentence under Section 47 of the Mental Health Act? I have given notice of this question to the Minister. I believe that he has already a very good idea of what I am going to say. What information can the Minister give the House about the number of prisoners transferred towards the end of their sentence—those are the key words—under Section 47 of the Mental Health Act.

Another point has been brought before me by these well-informed bodies. Has the Minister any information on the ethnic breakdown of prisoners transferred under Section 47? There is a growing suspicion that ethnic minorities are being maltreated under this section. I report what I have been told by these expert bodies. There is a growing suspicion that ethnic minorities are being transferred under the section. When I speak of MIND I am sure that everyone knows the famous society of that name. There is a growing suspicion not only in MIND about the mental health care of prisoners on remand. I have time only to mention two cases. Keith Hicks, aged 38, died in Brixton Prison on 12th March 1985. It was treated as a death following an epileptic fit. The handling of the case by the coroner gave rise to much criticism and after an appeal to the High Court a second inquest was held. The verdict of the second inquest was accidental death, aggravated by lack of care.

The second case concerns Samuel Carew who died in the same prison on 5th February this year, aged 22. He was found hanging in his cell. At Southwark Coroner's Court the verdict was suicide. The coroner was moved to remark: There is a terrible rottenness in the system that needs rectifying". The coroner set out a list of recommendations that I hope are available to the Minister. If they are not, I can supply him with them. I content myself now by asking the Minister what steps are being taken to give effect to at least some of the recommendations of the coroner.

I am close to concluding what I have to say. There are many matters that should be taken up with the Government. I am sure that some will be effectively dealt with by other speakers. There is the far-reaching question of psychiatric assistance within the prison system. I am not saying that anyone with a psychiatric problem should be transferred at once to hospital. The prison psychiatric service has to cope with many cases. The noble Lord, Lord Donaldson, has great experience of these matters and I hope that he will be able to deal with some of the problems. I am sure that the noble Lord, Lord Allen of Abbeydale, will return to the deplorable story of the regional secure units and that he will bring us up-to-date with the latest news from Broadmoor which I expect will be very bad, though I may be pleasantly disappointed.

There is one major issue that deserves a debate of its own: the after-care for patients who have been in special hospitals. That leads one to the question of after-care for ex-mental hospital patients. I chaired a committee on this subject some years ago and Lord Beswick, a great worker for these causes, opened a debate in the House. The subject is too wide for me to deal with it further today. However, the noble Earl, Lord Shannon, who is chairman of the Matthew Trust, may have something to say on that and other matters.

Ex-prisoners are protected after a certain number of years from references to their time in prison. It is a source of deep pain to those who have been in special hospitals and those who care for them that a similar protection is not extended. An additional point is that persons who have been in special hospitals are sometimes referred to as ex-patients of a criminal lunatic asylum. I have in mind something that was written recently in a highly reputable paper. Two points arise here. The first is any reference at all to their having been in a special hospital and, secondly, to their being described as having been in a criminal lunatic asylum—a total misnomer and one that has been so for many years. I hope that the Government and the noble Earl, Lord Shannon, will say something further about that. I hope that the Government will consider introducing legislation to make sure that the same kind of protection accorded to ex-prisoners is accorded to ex-patients of special hospitals.

I have hardly done more than touch upon the fringe of this baffling and often tragic subject. I hope however that the House feels, as I am sure it will after it has heard the other speeches, that this matter should be explored far more deeply and accurately. I hinted earlier that I believe this subject is avoided because it is so difficult. People turn way from it: I believe that is unworthy of a society that still claims, with some justification, to be Christian.

3.49 p.m.

Baroness Faithfull

My Lords, again we must thank the noble Earl. Lord Longford. for bringing this matter before your Lordships' House. We must admire his persistency in doing this. I cannot remember exactly how many times he has done so but I believe it is a number of times. We congratulate him and we are also grateful to him.

I believe that the most helpful books that have been written on this subject are that by Nigel Walker and Mrs. McCabe called Crime and Insanity (volume 2) and Larry Gostin's book, Human Condition of Mind. The two books make many recommendations but they have not yet been implemented.

For the purposes of my speech I should like to define the words "mental" and "offenders". We are discussing today what steps the Government are taking to provide more effective treatment for mental offenders. Offenders are those who have transgressed the law or who are alleged to have transgressed the law. When we try to define the word "mental" we run into problems and we have to turn to Part I of the Mental Health Act 1983 for a definition. The word "mental" can refer to several different areas—mental disorder, severe mental impairment, psychopathic disorders and arrested mental impairment.

I shall divide mental offenders into two sections. First, there are the gravely ill psychotic or psychopathic offenders who commit serious offences and need treatment in secure conditions. How secure should those conditions be, and for how long should the treatment last? The Mental Health Act 1983 made it possible for those who had committed serious offences to be discharged by mental health review tribunals if their consultant said that they no longer needed or were unable to benefit from treatment. This does not usually happen without the approval of the Home Office and the Department of Health, but it could happen. That is why the two departments issued in 1986 consultative document entitled Offenders Suffering.from Psychopathic Disorder. In it they suggested that psychopaths should no longer be able to be dealt with under the Mental Health Act but should be absorbed by the penal system, from which they could be transferred to hospital if this was felt to be necessary. This suggestion met with opposition and has not been followed up. Is the suggestion likely to be followed up? We realise that in this connection there are problems of justice and safety.

The second type of offender is the minor offender the chronic schizophrenic or irresponsible nuisance who might be called a psychopath. Both types can now be dealt with by hospital order. The trouble is that they become known to their local psychiatric hospitals and are such a nuisance that they are refused admission. The court cannot make an order, and in the face of a long penal history it has little option but to commit them to prison. In the present prison conditions of tremendous overcrowding this is no solution.

We have managed to bring down the number of juvenile delinquents appearing before the courts and the number of juvenile delinquents who are committed to penal institutions. This has been achieved by good relationships between the probation and social work departments and the police. In a number of cases the children have not been charged and alternative arrangements—most notably. intermediate treatment— have been made for them in the community. Is it not possible for some of the less serious cases—I say "the less serious cases" because obviously the serious cases have to come before the courts to be tried and dealt with in the ordinary way—to be dealt with in the community in a different way? There are perhaps an enormous number of people in prison, particularly on remand, who could he dealt with in this way. We would then not have to build the huge number of prisons to which the Minister referred earlier this afternoon at Question Time.

People ask how this can be done. I suggest that there are outstanding organisations in this country which to some extent are dealing with the problem. I refer to the Church Army, the Salvation Army, Hostels for the Homeless, an organisation chaired for a long time by the vicar of St. Martin-in-the-Fields, the Simon Community and the Cyrenians. Instead of giving so much money for the building of new prisons, might it not be more suitable to ask those organisations to administer hostels in the community to deal with people involved with less serious cases as an alternative to sending them to prison. I refer in particular to bail hostels, which were mentioned earlier this afternoon by the noble Baroness, Lady Seear. Do we use the community, the people in the community and the facilities in the community in the way that we should?

I have told the following story to the House once before but I feel I must tell it again because it emphasises what I mean. Every year old Joe used to come and wish me a happy Christmas. He always came two days before Christmas. I used to say, "But Joe, it isn't Christmas yet". He said, "Yes, but I have duties to do". On that evening I would read that he had clocked a policeman, and clocked him fairly badly, so that he could spend Christmas in prison. He had nowhere else to spend Christmas. We would not want to see the return of the old Poor Law Acts, but when we lost the poor law institutions we also lost the casual wards.

I would not wish to bring hack the casual wards but perhaps I may remind your Lordships about them. Every poor law institution in the country had a casual ward which accommodated about 12 people. They were roughly 25 miles apart. One could travel from John O'Groats to Cornwall and be sure that every 25 miles one could find somewhere to sleep that night. This was well outlined in the Autobiography of a Super Tramp. The casual wards had accommodation for about 12 men. At Christmas, instead of having to clock a policeman and get into trouble, the men would fall back on the casual wards. They got to know the staff of the wards. I know a number of schizophrenics and mentally-disturbed people who hitched on to the casual ward as a kind of lighthouse. They stayed there when they could bear life no longer. The casual wards did a magnificent job but one would not want to bring them back.

Instead of spending so much money on Christmas, could not the Government allocate it to the magnificent hostel organisations, with their outstanding voluntary workers? Those disturbed people could be organised through the local authorities, and every authority would have in its area a hostel or hostels to meet this need. We need to have a completely different view of many of our prisoners. A great many of them need not go to prison at all. However, we have to have the facilities for them. If we made such an appeal to the hostels we would have to give them the money to carry out the work we would want them to do.

Having said that, I should like to pay tribute to the prison staff who at present look after mental patients of the two types that I have enumerated. They have to do so in overcrowded cells, not having received any special training and without the provision of adequate help. I should also like to pay tribute to the staff in the psychiatric hospitals. I think that the work they carry out is quite outstanding and the mixture of people with whom they have to deal is extraordinarily difficult.

I have not attempted to deal with the very severe types of mental illness with which the noble Lord, Lord Allen, and others can deal far better than I. But on the less serious cases, I ask my noble friend the Minister whether we can look at the matter quite differently and have quite a different type of help available. I also ask whether we could not have some cases not coming before the courts at all but being helped in the community by the community.