MENTAL HEALTH ACT 1959 (AMENDMENT) (Hansard, 19 March 1969)

§ Mrs. Knight

I beg to move, That leave be given to bring in a Bill to amend sections 60 and 65 of the Mental Health Act, 1959. Sections 60 and 65 of the Mental Health Act, 1959, are those which allow for persons suffering from mental disorders who have been convicted in the courts to be admitted to mental hospitals or placed under the guardianship of a local health authority. These are not the only Sections concerning this type of patient. Section 72 is also involved to a lesser extent, since it deals with the transfer to mental hospitals of persons undergoing a sentence of imprisonment. However, the main problem for mental hospitals concerns Sections 60 and 65, since under these Sections a person may be admitted straight from the courts— admittedly after a medical examination, but before any experience has been gained as to the likely behaviour of that person when placed under duress.

In recent years a much more enlightened policy towards mentally sick people has led to what is termed the open-door mental hospital. The days when wild-eyed lunatics with matted hair and unwashed bodies were penned behind bars unseen and forgotten by all except those whose fearsome duty it was to care for them are dead, gone, and un-lamented. A visitor to a mental hospital today will go through open entrance gates and see the patients walking about normally, mostly free to leave the hospital whenever they wish. In fact, it is often difficult to tell who are the patients and who are the visitors. This policy contributes enormously to the large numbers of cures effected.

When convicted criminals are placed in this environment, the law asks mental hospitals to turn back the clock, lock the doors again, and take measures to become in part little prisons. The case of the mentally ill schizophrenic convicted of minor larceny offences and then sent to a mental hospital may not be so obviously difficult, because if he walks out, although he may be a menace to local shopkeepers, he will not be a danger to the public. The trouble with him is that he will probably not remain in the hospital long enough to get the treatment 524 he needs for his condition. The case of the rapist or aggressive psychopath is quite another matter. If he gets out, he constitutes a real and terrible danger to innocent people outside. On the other hands, if he stays in, it might well be said that he constitutes a similar danger to the innocent patients inside.

The Medical Director of All Saints Hospital in Winson Green, Birmingham, Dr. Norman Imlah, is a man who is much respected and admired for his work and experience both in All Saints and other mental hospitals. He recently gave a most serious warning that potentially dangerous patients can easily get out of Britain's mental hospitals. He has been joined in this opinion by other distinguished doctors and psychiatrists who feel a similar concern about the situation. We ignore the warning of these men at our peril.

Originally it was felt with some justification that it would be quite feasible to expect every mental hospital to provide some sort of special security section within the hospital to contain these patients. At present the Ministry places this responsibility on regional hospital boards which, in their turn, exert pressures on individual hospitals. Many hospitals do retain locked wards for this purpose. Others, where the locked door policy has been abandoned, cope with this problem as best they can by recruiting special supervisory staff.

It is becoming increasingly clear that these arrangements cannot work much longer. Medical and nursing staff detest having to be jailers one minute and nurses the next. Further, the retention of special security accommodation in hospitals has a very bad effect on the other patients in the hospital. As Dr. Imlah says, "If we are running a hospital of which people can have no fear, and to which they will come when they are in need of help, we simply cannot provide maximum security".

There are only four State security institutions in the country—Broadmoor, Rampton, Moss Side and Carstairs in Scotland. They are all crammed, bursting at the seams. There is only a slender chance of having a potentially dangerous patient put into one of them. What happens? The court is told that the man before it is mentally ill but there is no 525 room for him in the State security institutions. If the mental hospital flatly refuses to have him, he will have to go to prison, for there is no other place. Prisons are not hospitals, and it is most unlikely that he can receive in prison the medical treatment which he so desperately needs, and it is treatment, which may one day enable him to be rehabilitated in society.

Clearly, a third category of establishment is needed, not a Broadmoor and not a mental hospital but somewhere to which criminally convicted persons who are suffering from mental disorder may be sent and treated and yet be kept secure. Two consultant forensic psychiatrists holding appointments under the Home Office and the National Health Service, Dr. Westbury of Newcastle and Dr. Bluglass of Birmingham, have suggested the setting up of 100-bed special security units purpose-built to deal with this grave problem. Dr. Donald West, assistant director of research at the Cambridge University Institute of Criminology, also takes the view that there is a crying need for this sort of third unit. He points out in a recent article that other countries which have set up such units claim considerable success from them.

Of course, the bugbear of cost raises its head. We live in a "bread-line" Britain. Nevertheless, the problem will have to be tackled, and tackled soon. If the Bill is given a chance to continue on its way, I shall seek to establish plans whereby we may consider the building of such units, and I shall even try to suggest where economies can be made to help pay for them. Today, I ask only that the House recognise the problem and agree to consider a cure.