HC Deb 06 February 1963 vol 671 cc625-36

Motion made, and Question proposed, That this House do now adjourn.—[Mr. G. Campbell.]

1.24 a.m.

Mr. Leo Abse (Pontypool)

In 1961, on more than 100 occasions men and women in our prisons and borstals were placed in strait-jackets. More than half of the women suffering this treatment were young women inside our borstals. It is claimed by the Prison Commissioners that all those who have received what I regard as the ultimate outrage to human dighity were so treated at the direction of the prison medical service. It may well be that a handful of those so restrained subsequently had transfer directions made under the Mental Health Act, or perhaps were certified insane. But even if this proved to be the case, that every year so many are dealt with in this way is, in my view, inexcusable. In any self-respecting mental hospital today a strait-jacket would be regarded as a museum piece. Even a padded cell in a mental hospital is rarely used. These are days when a revolution has taken place in the field of mental health, when sedative drugs are readily available, when for the most part our hospitals have psychiatrists who can take nurses along with them in order to create a therapeutic team working towards a therapeutic community which ends the need completely of all mechanical restraint.

I believe, therefore, that we are entitled to ask: since the strait-jacket has, in effect, been abandoned in the mental hospitals, why is it that it is so persistently and extensively used throughout our prisons and borstals? What is worse is that it is being used for incredibly long periods of time. For example, in what prison and for what reason was one prisoner last year placed in a strait-jacket for a total of 47¾ hours punctuated only by one break of one hour after 24 hours? Why were sedatives not given in such a case, if such action was, indeed, really necessary? Was this gaol near a mental hospital? Were any outside psychiatrists called upon if the prison medical service could not immediately provide one? Surely in this day and age there can be little or no excuse for keeping a man as long as this in such a condition?

I am aware that there are other examples equally unsatisfactory in their complexion. I heard yesterday from the prison welfare committee in Warwickshire—the Society of Friends—of a case in which the strait-jacket was put on so tightly that the man was bleeding. I am informed by the society that the man was left in this condition—in the strait-jacket and bleeding—for over 24 hours.

It is highly unsatisfactory that every year young women in our borstals are being trussed up like chickens for hours on end, and it is particularly unsatisfactory when we find that the strait-jacket was used in 1961 almost 10 times more on women than in 1959 or in 1960.

The law insists that every effort should be made to avoid recourse to this type of restraint. I want to know whether the law is being carried out behind the prison bars or whether strait-jackets are being used as a means of unlawful punishment against refractory prisoners. If the Under-Secretary denies this and says that no one is put into a strait-jacket except for medical reasons and that the decision is one for the prison medical officer's professional judgment, why is it that there is a gap between the practice and judgment of those with psychiatric experience and qualifications inside the National Health Service and those doctors who are without this experience and are certainly, as we know from the composition of the prison medical service, lamentably without the necessary psychiatric qualifications and are on such a wide scale lacking even any diploma in psychological medicine?

At this time I am aware that, albeit belatedly, a study is being conducted into the future of the prison medical service, but the misgiving of which this straitjacket business forms parts shows that a clandestine, inter-departmental study, even if it is being assisted by two distinguished outside professors, is not enough. There are well founded beliefs that the hierarchical structure and insulation of the prison medical service from the National Health Service is leading to blunders of which these scores of people being placed annually in these straitjackets form but a part.

Because of the feelings on matters such as the one I raise tonight, if any confidence is to be felt in the result of the study—to which, to allay any suspicions, I anticipate the hon. and learned Gentleman wilt refer—then at least the study should become a full inquiry with opportunities for outside bodies and outside witnesses to give evidence and, further, the report of such an inquiry should be made public.

When there are suspicions of the kind I am raising abroad, and when there are responsible bodies ready and anxious to give evidence to an inquiry, I ask why the Home Secretary has so far refused to permit the present study to become a full scale enquiry. A number of responsible people have been in prison—because, for example, of their unilateralist views—and I understand that they, too, have important evidence which they wish to give. I ask the hon. and learned Gentleman why these outside bodies and witnesses are not getting this opportunity. What has the Home Office to conceal? It should surely be ready, when it has complaints of the kind I am raising, to seek for all constructive advice.

I recall that in 1959 I had occasion, in the course of my professional work, to visit a prisoner I was defending on a murder charge. He was mentally sick and was subsequently found guilty but insane. I was shocked to find that, before my arrival, he had been placed, in two different prisons, at Bristol and at Cardiff, in a strait-jacket. The first period was for 20 hours 45 minutes and the second for 21 hours 40 minutes. I believed then, as I do now, that only ignorance and psychiatric illiteracy caused that wretched man to be so used.

I myself spent some considerable time subsequently in the cells or in the prison hospital with him, both alone and with a psychiatrist, and, of course, at no time did I have any apprehension whatsoever. The fact is that fear and aggression on the part of the jailers mobilised violence on the part of the prisoner that understanding would never, never have provoked.

One of the prisons in which this man was incarcerated—at Cardiff—is only a few miles from a mental hospital with a battery of psychiatrists who certainly would have dealt with the man and, indeed, the prison officers without a strait-jacket ever being used. But as a consequence of protocol and the unfor- tunate isolation of the prison medical service from outside mental health services, no contact was ever established with that mental hospital, which meant that this unfortunate man had to spend more than 42 hours like a trapped animal.

I believe it is time that the Prison Medical Service was overhauled and that there was an intelligent ebb and flow between doctors inside our prisons and those within the National Health Service. I hope that the study which is apparently now being made will be conducted with speed, that it will take outside evidence and that it will speedily make its recommendations. But I also hope that in the meantime steps will be taken to scrutinise with care, and increasing care, any case, whether in prison or in borstal, where it is claimed that the use of a strait-jacket was necessary.

1.35 a.m.

The Joint Under-Secretary of State for the Home Department (Mr. Charles Fletcher-Cooke)

The pattern of the restraint jacket approved by the Secretary of State for use in prisons and borstals is officially described as a "loose canvas restraint jacket". I shall refer to them simply as jackets.

The use of any kind of restraint jacket is repugnant to my right hon. Friend, and, I am sure, 'to the doctors of the prison medical service, but in present conditions it is sometimes found necessary. Standing Orders, of which there is a copy in the Library, make it clear that the use of mechanical restraints is always undesirable and every effort must be made to avoid recourse to them. They are to be used only when they are strictly necessary. In the safeguards, which are numerous, before they can be used, it is made clear that they will be used only on medical grounds and not, as is sometimes suggested, as a form of unlawful punishment, and on the authority in writing of the medical officer. Every case must be recorded and reported, and the authority of a member of the visiting committee or board of visitors must be obtained.

If it is necessary to keep the jacket on for longer than twenty-four hours, after it has been kept on for twenty-four hours it must be taken off for at least one hour before being re-applied, and there must be other short temporary breaks as far as practicable. A prisoner under restraint must be visited by the governor at least twice in twenty-four hours, and by the medical officer at least twice, and more frequently as may be necessary. He must be observed by an officer at least every fifteen minutes.

The figures show that the staff have taken these instructions to heart. The daily average population of men's prisons and borstals in 1961 was about 28.000, representing over 10 million man days of custody. Since the number of occasions on which a jacket was used, as I said in my Answer to a Question recently, was 86 in 1961, on eight of which the restraint was continued for part of a second day, the incidence of the use of the jacket was as 94 is to 10 million.

As regards females. I was unaware that the hon. Gentleman was going to raise this, and I must confess that I am not provided with the information. I shall certainly let the hon. Gentleman know the true information, and I shall publicise it as best I can because I am very surprised at the information he has given to the House.

It has been argued that some or all of the occasions could have been avoided, but, in view of the proportion I have given, it cannot be said that this measure is freely resorted to, or indeed that its use in practice reflects any neglect of the stringent Standing Order to which I have referred.

Conditions in prisons, particularly in overcrowded prisons, as I regret they are today, lead to tensions which lead to violence. A local prison must receive everyone the courts commit to it, a heterogeneous flood consisting mostly of ordinary law breakers who are suffering from no mental disorder. It includes, however, some who are so suffering but attempt to conceal it, and others who are not so suffering but have everything to gain by pretending that they are.

In the majority of prisons the prison medical officer called to treat a prisoner who is being violent by reason of mental disturbance—and I would emphasise that in no other case does the use of a restraint jacket come into question—will not necessarily have the same experience of dealing with violence by sedation as the staffs of the mental hospitals with whom the hon. Gentleman has drawn a comparison.

Some immediate action is required to prevent the prisoner from injuring himself or others or creating a disturbance, which in a prison, could have serious consequences. Every effort is made to quieten the prisoner without recourse to mechanical restraints, including the use of sedation if the prisoner can be induced to accept it. But in a small proportion of cases the choice must be between mechanical restraint and the injection of a drug into a resisting prisoner. This choice is a matter for the professional judgment of the individual doctor. I can, of course, express only a layman's point of view, but I can well understand that a doctor who does not have the resources of a mental hospital immediately at hand, may reluctantly prefer the alternative of a mechanical restraint, repugnant as it is, to the risk to the patient—broken needles and so on—involved in the administration of a drug to a violently resisting subject in the conditions then existing. There is a very great difference between a mental hospital and a prison. In a mental hospital there is no question of the patient's consent being given to sedation if he is compulsorily detained. If he is a voluntary patient he can refuse his consent by walking out, but in the case of a prisoner who objects to an injection, it is exposing the doctor to the obvious dangers of an action for assault if he nevertheless, in spite of the prisoner refusing his consent, proceeds to inject him.

Mr. Abse

Is the hon. and learned Gentleman seriously suggesting that it is not an assault to put a strait-jacket on a man? How does he distinguish between the administering of a drug, which he says constitutes an assault, and the putting on of a strait-jacket? Surely equally both of them are done without the consent of the patient? Surely his argument that the mental condition of the man is different from that of the mental patient falls to the ground, since I understood that the only reason the jacket would be put on would be the mental condition of the gaoled man.

Mr. Fletcher-Cooke

A man of such violence is prima facie in a mentally disturbed condition, but it is a much more serious matter to inject someone with a drug against his consent than to put him in a restraint jacket. The restraint jacket comes off, but once one starts injecting people with drugs against their will the consequences, as the hon. Member will appreciate, must be very serious indeed. There is all the world of difference, I submit, in these two methods of overcoming the resistance of a violent prisoner.

Power exists, of course, under Section 72 of the Mental Health Act, 1959, to transfer a prisoner suffering from mental disorder of a certain nature and degree, to a hospital, and this is always considered in appropriate cases. This procedure, however, involves at least some delay and affords no opportunity of immediate measures, yet the prisoner must be quietened as soon as possible in the prison where he happens to be. No one pretends that this situation is satisfactory, nor do I claim that the measures we have in hand will provide a complete solution. That only experience can show. But substantial measures are being taken to improve the situation in which this unavoidable necessity arises and I shall mention sonic of them.

Before doing so perhaps I should deal with the individual cases which the hon. Member has mentioned. He was kind enough to notify me yesterday, or the day before, that he would raise the question of the prisoner, mentioned in my Answer to a recent Question, who was under restraint for a continuous period of forty-seven hours with temporary breaks. I sent to the prison concerned for the original papers of the case referred to. These papers were examined on their arrival in London today and it was found that when the information was collected from prisons for the purposes of the Answer there was a clerical error, namely confusion between a.m. and p.m., in the reports supplied on this prisoner, who was in fact kept in a jacket not for forty-seven but for thirty-five hours. My original Answer, therefore, was incorrect, and I apologise to the hon. Member and to the House.

At the same time I should like for the completion of the story to make clear that there were in fact in 1961 two prisoners who were kept in a jacket for just over forty-six hours. The first case was that of a prisoner who inflicted an injury on himself by cutting his right forearm with a razor. He was placed in a jacket in order to prevent his injuring himself further, and was given eight partial releases of periods from 10–20 minutes, as well as the continuous total release of one hour, 24 hours after being placed in the jacket, as required by Standing Orders.

The other case was one of a prisoner who was fighting and struggling and attempting to attack others. He was placed in a jacket for the protection of others and was given a similar number of temporary releases, as well as the total release of one hour required by Standing Orders. The medical officer, in the second case, considered that the prisoner's mental disorder might be of such a nature and degree as to justify his transfer to hospital under Section 72 of the Mental Health Act. However, an outside psychiatrist, called in consultation in accordance with the prescribed procedure, decided that there was not sufficient justification for him to make a recommendation for transfer to hospital. In both cases the regulation requiring the authority of a member of the Board of Visitors to be obtained for retention longer than 24 hours was complied with.

I cannot mention the case the hon. Gentleman raised on behalf of the Society of Friends concerning someone who had been in a jacket for 24 hours and was said to be bleeding. I will look into the case if the hon. Gentleman will supply me with the name. I should very much like to check up on it, as from what the hon. Gentleman tells me, particularly the aspect of bleeding, it seems to me to be highly improbable. However, I will certainly go into the case if the hon. Gentleman will give me further particulars.

The hon. Gentleman mentioned the working party which my right hon. Friend has set up including representatives from the Ministry of Health as well as from outside the public service to study the work of the prison medical service in relation to that of the National Health Service with the object of securing that prisoners in need of medical treatment receive the benefit of the best methods available. Although I am sure that this is a good step to take, I hope that nothing which has been said tonight will be taken by any of the prison medical staffs as in any way reflecting on the high sense of duty with which they carry out their responsibilities, often under very difficult conditions. My right hon. Friend and I fully recognise that prison medical officers are second to none in their zeal for the welfare of their patients and their devotion to the highest standards of the profession.

The working party is composed primarily of Government servants, and it is, I think, without any sort of precedent that its report should be published as requested by the hon. Gentleman. On the other hand, it is receiving and hopes to receive further evidence from outside bodies—the Royal Medico-psychological Association, the National Association of Mental Health and the British Medical Association. It is understood that the Institution of Professional Civil Servants and the Howard League for Penal Reform will submit evidence. The working Party has decided to ask a number of outside bodies—the Royal Medico-psychological Association and others—whom it considers have particular knowledge and a special contribution to make to appear before it and tell it what they can of this very difficult subject. I think that this is a most valuable endeavour and one which we all hope will be speedily completed.

I conclude by saying a word or two about the practice of restraint in the world as a whole and in the prison world. It is interesting to look for a brief moment at the circumstances in other countries. The standard minimum rules for the treatment of prisoners adopted by the United Nations in 1955 specifically mention restraint jackets as one of the instruments of restraint whose use is contemplated. The rules in this country restrict the use of restraints far more than the United Nations rules require. In many particulars the safeguards are greater than those set down by these standards. I would not claim to be fully informed as to the exact practice regarding the use of mechanical restraints in all other countries, but I am informed that in a number of countries in Europe, including some Scandinavian countries, physical restraints may be applied to prisoners suffering from mental disturbance. In these countries I understand that a jacket is not used but that the restraint takes the form of a special bed with a body-belt and anklets attached to it.

There is obviously room for differences of view as to what pattern of restraint is most suitable, if physical restraints are to be used at all; but the loose jacket used here, horrible though it may be, is far less restrictive to the prisoner than the form of restraint I mentioned a few minutes ago where the lower part of the body is actually tied down to the bed.

Mr. Abse

Our mental hospitals are also very overcrowded. Instead of making comparisons with what may be going on in other parts of the world, why do not the prison medical officers endeavour to gain experience and understanding from mental hospitals, because those qualities are certainly applied in every progressive mental hospital, where even without sedation it is possible to handle these patients, except in a very small proportion of cases, without resort to any of these barbaric and, in my view, mediaeval practices which are more reminiscent of Bedlam than of a decent mental hospital?

Mr. Fletcher-Cooke

I have tried to point out that the conditions under which those in mental hospitals work are totally different from those obtaining in prisons. The hon. Gentleman says that only a small proportion of cases in mental hospitals needs to be dealt with in this way. The same is true as to prisons. The figure of 86 out of a total population of about 30.000 shows that only on a minute number of occasions is this necessary. I do not accept the view that it would be, certainly in the present state of the system and of the law, correct to advise that laymen such as the Prison Commissioners should instruct or advise prison medical officers in what way they should carry out their duties, namely that they should forcibly inject violent prisoners, because that must be a matter for the medical men themselves and not a matter for the laity to instruct them about. To instruct doctors on how they are to do this—because this sort of restraint can be used only on medical grounds—would be a gross interference with the professional standing and duty of the medical profession. They will not do it at present. They say that it would be wrong to inject a violently resisting prisoner against his will. If that cannot be done, some other method must be found.

I believe that this method, repugnant though it is, in fact does less damage to the prisoner. Certainly so far as we know, no permanent damage is done, whereas the injection of a violent prisoner might do very serious immediate physical damage. To advance the theory that doctors are entitled to inject people against their will would open up a very dangerous line of argument.

The Question having been proposed after Ten o'clock on Wednesday evening and the debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at six minutes to Two o'clock.