HC Deb 20 February 1969 vol 778 cc933-42

11.55 p.m.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Charles R. Morris.]

Mr. Roy Roebuck (Harrow, East)

I am grateful for the opportunity to raise on the Adjournment the disturbing case of John Erico Silver, and my thanks are also due to my hon. Friend the Minister of State at the Department of Social Services for being here at so late an hour—I almost said at so early an hour. I think that we are coming up to our sixteenth hour. Note might be taken of that by the National Board for Prices and Incomes.

The brief circumstances of the case are that Mr. Silver, who has a history of mental illness and violent behaviour, took his wife and four children on a riverside picnic in a spot near Little-hampton, in Sussex, and there tied up his wife. When she escaped he killed his children, aged between six and two, with a hammer. What I wish to explore tonight is the nature of the treatment received by Mr. Silver before that ghastly event to try to discover how it came about that medical authorities who had had him in their care came to allow him to be at large.

I need to tell the House at this stage that at Sussex Assizes on 19th December Mr. Silver pleaded not guilty to murdering the children but guilty to manslaughter. The court was satisfied that he was suffering psychopathic disorders within the meaning of the Mental Health Act, 1959, and made an order under Section 60 of that Act for his detention in Broadmoor Hospital. The court also thought that it was necessary for the protection of the public to make an order under Section 65 of the Act requiring him to be subject to the special restrictions set out in that Section without limit of time. The chief effect of that order is that Mr. Silver may not be discharged from Broadmoor or transferred to another hospital without the consent of the Secretary of State for Home Affairs. The implications of that order will be of some comfort to those of my constituents who have raised this case with me—in an extremely reasonable manner, if I may say so—and have very properly sought certain assurances.

The matter was brought to my attention at Christmas by two members of Stanmore Baptist Church. Some of the good people associated with that church, which is one of the most respected institutions in my constituency, had for some time before the tragedy been giving aid and comfort to the Silver family— acting as Good Samaritans to them in their time of trouble.

It is clear from the testimony of two of my constituents that the mental health authorities and the police at Edgware knew for some time that Mr. Silver was mentally unbalanced to a degree that made him a potential danger to his family —and, indeed, to other members of the community. I quote from one of the letters which I have received, from a Stanmore constituent: Mr. and Mrs. Silver and their children lived near us for two years—from 1964 to 1966—and my wife and I were very concerned at the way Mr. Silver ill-treated his wife and children. On many occasions police were called to their home and, such was his ferocity, they would send a minimum of eight to deal with him on each occasion. I will interpolate here, so that the House may obtain a proper understanding of the situation, that I am informed that Mr. Silver is 6ft. 8in. tall and at the time of the killing was aged 28, and that his employment was that of a timber porter. My constituent continues: It was very obvious from this man's behaviour that his attacks on his family were likely to lead to the death of one or other of them unless he was detained. This point of view was impressed on the medical authorities and others concerned with his case, but no effective action was taken until the death of the four small children. My constituent continues, It seems to me that, in particular, the Home Secretary should direct his attention to the activities or inactivity of the responsible officer at the Shenley Mental Hospital. Although Mr. Silver went to the hospital for treatment over a period of months, he was allowed home again to continue the ill-treatment of his wife and family until eventually he carried out the act which many of us who had tried to bring help and comfort to this small family had anticipated for some time. As the House knows, it is, in fact, my right hon. Friend the Secretary of State for Social Services who carries responsibility for persons needing treatment for mental disorders, including their supervision in the community and their informal or compulsory admission to hospital for observation and treatment; and so it is to his Department that I address my inquiries tonight. It will emerge later that Mr. Silver had, in fact, been seen by mental health doctors over a period of years, not months.

My constituent goes on to ask whether there has been some failure on the part of the medical authorities, particularly at Shenley Hospital, and concludes: No action can now bring those four young lives back, but the least those of us who are deeply aware of the circumstances of this case can do is to try to get effective action taken to stop another tragedy of this kind before next Christmas comes round. That is the purpose of my raising this matter on the Adjournment tonight.

The evidence I have just quoted with regard to the knowledge which the mental health authorities had about the dangerous nature of Mr. Silver's affliction is corroborated in a letter from another constituent, who says: I am only anxious that nothing like this occurs again. … It was a great tragedy but, even more so, as it could so easily have been avoided. In another letter to me, the same constituent says: Our main concern is to do what we can to ensure that similar cases are not allowed to develop in the same tragic way These are letters from good citizens, kindly, Christian folk who have tried to do their duty and who clearly feel that the authorities have let them down and that there has been a failure in the operation of the mental health services. I communicated with my right hon. Friend the Secretary of State on 27th December last, and when, despite a reminder, I had not received a substantive reply by last Wednesday, I feel it was appropriate to seek to bring this matter to the House.

I understand that before coming to live in my constituency, Mr. Silver had treatment at Cane Hill Hospital, Coulsdon, Surrey, and for a long period at the Henderson Hospital, Sutton, Surrey, which deals mainly with personality and psychopathic disorders. While living in my constituency, he was detained under Section 25 of the Mental Health Act from 6th August, 1965, to 3rd September, 1965. Subsequently, on 5th July, 1966, he was again admitted to Shenley Hospital, but discharged himself on the same day. He was admitted to the hospital again on 4th November, 1966, and stayed there until 7th August, 1967. Four days after his discharge he was in trouble with the police and, as a result, he was admitted yet again to Shenley Hospital, this time under Section 136 of the Mental Health Act, 1959, which says: (1) If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of the last foregoing section. (2) A person removed to a place of safety under this section may be detained there for a period not exceeding seventy-two hours for the purpose of enabling him to be examined by a medical practitioner and to be interviewed by a mental welfare officer and of making any necessary arrangements for his treatment or care. Mr. Silver apparently left the hospital against medical advice on 26th August, 1967. It would appear that the policeman—whose name I do not know—who apprehended Mr. Silver was a man of considerable perception. I hope that perhaps his superiors take note of this. It is perhaps a pity that the same perception was not also demonstrated at Shenley. Perhaps my hon. Friend can give a satisfactory explanation.

There followed after his discharge the melancholy events which I related at the beginning of my speech.

The House will be concerned about the circumstances of Mrs. Silver. I have not met her, but I understand that she is a lady of great fortitude and resolution. She has taken a post in another part of the country under a different name and is endeavouring to rebuild her life. The House will want to salute her courage and to wish her well, and it is my hope that she will be left undisturbed to try to forget the appalling experiences she has endured. The House will also expect from my hon. Friend an extremely full examination of this case.

I ask my hon. Friend three questions: Has there been any slackness on the part of the mental health authorities? If so, what administrative action does he propose to take? Thirdly, can anything specific be done to guard against the possibility of such a tragedy happening again?

To paraphrase the letter of one of my constituents, our main concern must be to see that similar cases are not allowed to develop in the same way.

The Minister of State, Department of Health and Social Security (Mr. David Ennals)

I fully share the distress which my hon. Friend the Member for Harrow, East (Mr. Roebuck) has so ably expressed concerning these tragic events and his sympathy for the wife and the tribute which he has paid to her. It is right that he should be raising this matter; it is one of great public concern and interest. It is also important that it should be put into its proper perspective and that blame should not unjustly be laid on the hospital at which John Silver had previously been a patient.

I express my apologies to my hon. Friend that the letter which he wrote to my right hon. Friend on 27th December has not received a substantive reply. This was because the substantial inquiries which had to be made of the Home Office and of the hospital management committee took some time, and we were just ready to reply to my hon. Friend's letter when he gave notice of this debate.

Perhaps I may fill in the background. The provisions of the Mental Health Act, 1959, are largely based on the recommendations of the Royal Commission on the law relating to Mental Illness and Mental Deficiency, whose Report was published in 1957. One of the principles embodied in that Report was that patients suffering from mental disorder should, so far as possible, be able to enter and leave hospital with no more formality or restriction on liberty than patients with physical illness. Most patients in psychiatric hospitals are therefore treated and cared for on an informal basis and are free to leave hospital whenever they wish. But the need to protect the interests of the community is nevertheless recognised by the Act, and a number of compulsory powers of admission and detention were retained by it for use in circumstances which Parliament accepted would be appropriate, either in the interests of the patient's own health or safety, or for the protection of others.

Some of these powers, those under Part V of the Act, apply only where the person concerned has been convicted or charged before a court with a criminal offence. There are also provisions, however, applicable to persons who have not been concerned with criminal proceedings. They include provisions for emergency removal for examination, for compulsory admission to hospital for observation and for compulsory admission to hospital for treatment. It is this last provision that we must look at particularly in relation to this case.

The relevant provision is in Section 26 of the Act, which provides that an application for admission for treatment may be made in respect of a patient on the grounds that he is suffering from mental disorder, being—

  1. (i) in the case of a patient of any age, mental illness or severe subnormality;
  2. (ii) in the case of a patient under the age of 21 years, psychopathic disorder or sub-normality …"
A most important point about this provision is the distinction which it makes between mental illness and psychopathic disorder. In the case of mental illness the patient's age is immaterial. In the case of a psychopathic disorder, on the other hand, the application can be made only if the patient is under 21.

This distinction in Section 26 is not accidental, and the Royal Commission had a good deal to say on the subject. "Psychopathic disorder" is defined in Section 4 of the Act as a persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormality aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment. However, this definition does not provide an entirely objective criterion, and broadly the situation in 1957, and still today, is that the diagnosis of psychopathic disorder is not a precise clinical technique, nor is there any generally recognised effective form of medical treatment for it. It is the patient's behaviour which generally provides the main evidence of his mental condition, and such experience as has been gained on the treatment and training of the psychopath points to a greater likelihood of success if treatment or training is given during adolescence or early adult life. Some psychiatrists who attempt to treat psychopathy also regard the willing co-operation of the patient as of the utmost importance. It was against this background, therefore, that the Royal Commission had to weigh up the risks to which a psychopath's anti-social actions can give rise against the other risks inherent in recommending for a somewhat ill-defined disorder a curtailment of liberty dictated by the interest of the public rather than of the patient. The opinion which the Royal Commission formed was as follows: We . . consider it justifiable that psychopathic patients, as well as patients suffering from other forms of mental disorder, should be liable to compulsory admission to hospital at any age for a period not exceeding 28 days for the purpose of medical observation and preliminary treatment, if this is necessary for their own welfare or for the protection of others. If further hospital or community care is then recommended we hope that at least some patients will be willing to receive it on a voluntary basis. Nevertheless, … we do not consider that there is sufficient justification for special compulsory powers in relation to adult psychopathic patients except when their conduct is antisocial to the extent of constituting an offence against the criminal law. This is the key point.

Section 26 of the Act reflects this recommendation, and I think it is fair to say that Parliament quite specifically accepted the recommendation since an amendment to remove the exclusion of adult psychopaths was withdrawn after the debate in the Standing Committee on 26th February, 1959.

The position is thus that in law, if a psychopathic patient is not already detained in hospital when he reaches the age of 21, he cannot subsequently be detained on this ground for more than a limited period for examination or observation unless he has committed an offence against the criminal law.

Turning now to this particular case, John Silver had been a patient in psychiatric hospitals on a number of occasions since 1960, and since 1965 he was ad-admitted four times to Shenley Hospital where he was diagnosed as suffering from psychopathic disorder. Two out of these four admissions were compulsory for observation or for examination, but on all four occasions he either initially was, or subsequently became, an informal patient, and was free to leave the hospital when he chose.

During the period of some three years from August, 1965, to September, 1968, John Silver spent about 10½ months in Shenley. For more than twice that period therefore, including a period after his final discharge, he had lived outside the hospital without serious consequences.

I am, of course, aware of what has been said by members of the public, and quoted by my hon. Friend, about his outbursts, and those responsible for him at Shenley Hospital were well aware that his history included violence and threats of violence. My information is never-less that, although various incidents were reported to the police, there was no occasion on which these led to a criminal prosecution. Nor have I found any evidence that the medical authorities were at any time specifically warned of circumstances indicating that his outbursts were likely to lead to serious injury to members of his family. I also understand that it was after he finally left Shenley Hospital that the Divorce Court specifically gave John Silver access to his children and thus brought him into contact again with his family, giving rise to circumstances which had such tragic consequences.

My hon. Friend has referred to some of his constituents, and I respect and feel sad for them in the position in which they find themselves, but I am not persuaded that the facts of the case are such as to justify our saying in the light of what subsequently happened that even before the tragic events of September last year it was clear that John Silver was a person whose detention was essential in the interest of public safety. Nor am I persuaded that this case would justify our saying that the Royal Commission was wrong in its closely considered recommendation as to where the line should be drawn on compulsory detention of an adult psychopath. I can understand the view that someone must have been at fault when a mental patient is allowed to leave hospital and subsequently commits so dreadful a crime.

I hope that what I have said makes it clear what the limitations were on the courses open to the hospital authority even had there been grounds for suspecting a grave risk of injury by John Silver to his family or to others. Nothing I have discovered indicates that the hospital service was in any way at fault so far as John Silver's discharge was concerned.

The present position is that as a result of the court proceedings he is now detained in Broadmoor Hospital by means of an Order made under Section 60 of the Mental Health Act at Sussex Assizes on 19th December last. He is also subject, for an unlimited period, to the special restrictions set out in Section 65 of the Act. The chief effect of this is that he may now not be discharged, granted leave, or transferred to another hospital without the consent of my right hon. Friend the Home Secretary. My right hon. Friend is always most concerned to ensure that the safety of the public is not endangered by the release from hospital of a patient for whom he is responsible and his consent is given only after full consideration of the possible risk to the public.

From the evidence which my hon. Friend has put before the House, there are factors in this case which I believe require further inquiry. There will be a further inquiry, and I shall report the outcome of this to my hon. Friend. I thank my hon. Friend for raising this matter. I think that he has done a service by raising this issue in the way that he did.

Question put and agreed to.

Adjourned accordingly at sixteen minutes past Twelve o'clock.