§ 9.51 p.m.
§ Dr. Michael Winstanley (Hazel Grove)
I am most grateful for this opportunity to raise the difficult, worrying and distressing subject of the release from hospital of patients detained under Section 60 of the Mental Health Act.
This is an area in which there is some public anxiety. It is one in which mistakes are very rare, although there have perhaps been one or two recently. If a mistake occurs, it can be very damaging to those administering the law and can put back the clock with regard to the reform of the penal law in this respect. It is important that the public should be satisfied that this aspect of the law is administered justly, sensibly and safely.
I am prompted to raise this difficult subject by a distressing case which occurred in my constituency. It is one which has already had much publicity and is the subject of local controversy. Therefore, it seemed to me that nothing but good could be done by obtaining the true facts from the Minister concerned. I hope that the hon. Gentleman will deal with the case and then go from the particular to the general, so that we may have a better understanding of the procedures.
Less than a year ago the only child of two of my constituents, a girl aged two, was killed by a 21-year-old girl who was sitting in. The girl then went direct to the police and reported that she had killed the child. She appeared before the Manchester Crown Court on 12th October, when she was found not guilty of murder but guilty of manslaughter on the ground of diminished responsibility.
The court considered medical reports on the girl's state of mind and made a hospital order under Section 60 of the Mental Health Act 1959, coupled with an order restricting discharge—without 1692 limit of time—under Section 65. The principal effect of that latter order is that the patient may not be granted leave or be discharged from hospital without the Home Secretary's consent. The girl was then admitted to Parkside Hospital in Macclesfield.
In raising this distressing matter, I am not seeking to reopen old, very painful and distressing wounds for the bereaved couple whose child was killed in those tragic circumstances, nor do I wish to cause distress to someone who has been suffering from a serious mental illness, schizophrenia. Schizophrenia is a very distressing disease affecting almost anybody of any age. It could affect any one of us. We are not talking of a different class of person. We are talking about any of us who might develop this distressing illness called schizophrenia at any time.
In cases of that kind we do not consider punishment. Nobody would consider that there is any place for punishment of persons who have committed offences while they are suffering from a mental disease and who are not aware of the nature of the act they are commiting or are not responsible for their actions. In such cases, two matters arise—first the treatment, care and cure of the mentally afflicted person; second, the safety of the public as a whole.
Mistakes in this field are very rare. Should a mistake occur it can be damaging. It can undermine public confidence in the law and administration of the law. The law must never in this field appear to be out of step with public opinion. If the public lose confidence, great damage is done.
The girl in question went to a hospital in Macclesfield seven months ago. I was approached by constituents who learned five weeks ago that the girl was out and about in their own shopping area, frequenting public places and shops in the area in which they lived—that is, less than seven months after sentence had been pronounced on the girl. Not unnaturally, the bereaved parents were uneasy and worried. They live in Hazelgrove. The girl's parents live in an immediately adjacent area on the outskirts of Stockport. The girl frequents the same shopping area, the village of Hazelgrove.
1693 The parents approached me, as they were very worried. They felt that a mistake had been made. It seemed to them that the girl had been released very soon after sentence. They were concerned that they might meet this girl in the shops in the district and they asked me to raise the matter. The matter was raised in the local Press and has been the subject of some local controversy. I do not say that a mistake has been made. However, the matter having been raised, certain questions spring to mind.
I speak not only as a Member of Parliament but also as a doctor. I am not a specialist in psychiatric conditions. Schizophrenia is a very difficult illness; it is unpredictable. The behaviour of people suffering from schizophrenia cannot easily be predicted. One sees so many cases in which the results are not what one expects or hopes for. In recent months rapid strides have been made in its treatment. But as a doctor I would find it difficult to certify with complete confidence that a person sentenced in those circumstances only seven months ago had become safe to be released to the community in which she formerly lived. On the other hand, I do not say she is not safe.
One wonders about the case. This girl is being released on weekend leave in the care of her parents, perhaps preparatory to later release, as a kind of therapeutic test to see how she progresses in her home circumstances and ordinary background. If her treatment had been successful, she could be regarded as being cured and released in that way.
It is unfortunate that her parents live in the same district so that she meets people who are aware of all the circumstances and who will constantly remind her of that tragic episode. That may be placing additional stress on the patient.
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Alexander W. Lyon.]
§ Dr. Winstanley
If it is alleged that the girl, with treatment, has completely recovered from her previous condition, one must ask oneself a question. Had I committed an act of this kind in a schizophrenic episode—and that is per 1694 fectly possible; none of us should be smug about it because it could happen to anyone—and if I were cured, would I feel that it was wholly right that I should be out and at large in that same district within only seven months?
It might be helpful if the Minister took the opportunity to outline the procedures and safeguards which his Department adopts in these cases generally, because if the law is to work, and if people are to have confidence in the administration of the law, it is important that they should know that the law is operated safely. It would be helpful if he would spell out the steps his Department takes. It would be helpful, too, if he could outline the steps taken in this particular case. How many consultants have been asked their opinion on the case? Has this step been taken on the advice of only one consultant psychiatrist, or has more than one opinion been given?
Since the girl is returning to her home and to the care of her parents, and since she is 21 and the parents, presumably, have no direct control, because she must be a fairly free person and able to move about, what kind of psychiatric and social service support is being provided during the weekend periods of freedom?
What, if any, conditions are attached to these weekends of leave? Is the girl prevented from taking up employment? Are there any restrictions on the way in which she may move about in the community? I am not suggesting that there necessarily should be but I should like to know what consideration has been given to the matter.
As with all cases of this kind, I hope that this unfortunate person who committed this terrible and tragic act in the course of a serious illness will make a complete and final recovery and that, having made it, she will be ultimately integrated into the community. For the moment, however, what conditions have been attached to the periods of release? Treatment for schizophrenia has improved. What treatment has been given in this case and what guarantee does the Home Secretary have that the treatment will be maintained during these periods of leave? If, as I suspect, the treatment is given in the form of long-acting injections, that is a satisfactory answer. The injections will presumably 1695 be given before the weekend release begins and their effect would continue until after the release was over. That will not apply at a later stage if there is permanent release, but that is not a matter for consideration tonight.
I fully understand, as I am sure the Minister of State does, the anxiety of those parents who were bereaved in such a tragic and horrible way. I do not think that in approaching me they were activated by malice of any kind, but they had a genuine anxiety whether the right thing had been done. I hope that the debate will demonstrate beyond peradventure that what is being done is right and safe for the community as a whole, or, alternatively, that if what has been done is not right and an error has been made, this will be seen as an opportunity to rectify that error.
§ 10.5 p.m.
§ The Minister of State, Home Office (Mr. Alexander W. Lyon)
I am grateful to the hon. Member for Hazel Grove (Dr. Winstanley) not only for the moderation with which he raised the difficult issues involved in this case but also for giving me the opportunity of reassuring his constituents and public opinion generally about the care we take in relation to all patients in mental hospitals who are the subject of Section 65 orders under the Mental Health Act.
If an accused person coming before the courts is convicted of a criminal offence and the court feels it right on the medical evidence to make a Section 60 order, which is for compulsory detention in a mental hospital for a period of up to 12 months which may be renewed by the doctors after that period of time, or a Section 65 order, which means that the patient is detained in the mental hospital under restrictions which have to be supervised by the Secretary of State for the Home Department and which can be removed only at his pleasure, the burden falls upon the authorities to assure the public that when they make decisions in relation to patients they do so with an awareness of the possible danger that may befall the public.
Equally, it has to be borne in mind that these are mental patients. The assumption behind the order itself is that they are sick, not that they are criminals. If it transpires that the treatment which 1696 is afforded to them in the hospital is capable of curing them to the extent that they can again live normally, or almost normally, in the community without danger to the public, in those circumstances it is right that there should be a decision to release them. Otherwise one would be penalising them for a criminal offence for which they were not mentally responsible but which was merely a symptom of their illness. Therefore, in all these cases the question is: how far is it right to judge that the patient has recovered his mental health and is therefore able to resume his place in society without danger to society?
Those are basically medical questions. Inevitably we rely upon the experienced judgment of consultant psychiatrists and other doctors in advising us, in so far as it falls to the Home Office to deal with these matters, about their judgment of whether it is safe to release a person. But we still have to make a judgment in Section 65 cases about whether restrictions can be removed, and from time to time in the interests of the public it is thought necessary to disregard the medical judgment and to take extra care. Since the burden falls upon me to advise the Home Secretary in most of these cases that have to come to Ministers, I take the view that the safety of the public is paramount. Unless I am satisfied that all the indications are that the patient is as safe as reasonable human judgment can suggest, I take the view that it is better to wait until that kind of judgment can be made.
Inevitably, however, it is ultimately a human judgment, and sometimes mistakes can be made. If a mistake is made, I hope the public will understand that every care has been taken before the release of a mental patient to ensure that that does not happen. Occasionally, however, as the hon. Gentleman has said, there will be mistakes.
There are at present about 2,000 restricted patients under detention in mental hospitals of whom about 65 per cent.—that is, 1,300—are in three special hospitals, Broadmoor, Rampton and Moss Side. The others are maintained in National Health Service hospitals and represent about 1.3 per cent. of the total population of those hospitals.
The girl to whom the hon. Gentleman has drawn attention was the subject of a 1697 Section 65 order. This deals with the restrictions relating to the Secretary of State's powers. The girl was in a National Health Service hospital rather than in one of the special hospitals. That decision was taken on the advice of the psychiatrist who advised the judge at the trial. Both the judge and the psychiatrist took the view that although what she had done was a serious and distressing crime to the parents of the child, given proper medication this was not someone who was likely to be a danger to the public.
This person is now aged 22 physically. Emotionally she is very much younger, about 15. In the hospital where she has been treated she is called "the child". Her emotional immaturity is reflected in her appearance as well as in her conduct. She looks a frail, inadequate personality. She had had difficulties before the occasion when she was committed for this offence, but nobody had thought that she was suffering from a mental illness.
After the murder took place in the circumstances in which the hon. Gentleman has described—the charge was later reduced to one of manslaughter on the grounds of diminished responsibility—it was discovered that the girl was suffering from schizophrenia. She had all the hallmarks of that illness. She was hearing voices, and it was the voices which told her to kill. She had a flattening of her emotional tone and she was suffering from an apparent failure to appreciate the gravity of what she had done. Happily, schizophrenia is one of those mental illnesses which is susceptible to quick treatment by modern drugs. She was admitted to the hospital in Macclesfield and was given medication by the injection of Modecate into the muscle.
As I understand it the virtue of this treatment is that the Modecate is injected into the muscle and gradually distilled so that it can have a restraining effect upon the personality for quite a substantial time, up to a fortnight I gather. Under that kind of medication the girl made rapid and visible improvement, so that by December, although she was admitted early in October, the consultant thought that she had made sufficient progress for him to be able to consider periods of leave. Discussions were entered into with the Home Office because the Home Secretary's consent was required for such leaves. It was not until April that consent 1698 was given. Not only had she made visible improvement, but because of her kind of personality it had distinct therapeutic advantages to allow her to have weekend leaves with her family.
Apparently she is the kind of girl who reacts easily to the influences around her. For instance, in recent months she has been in contact with a girl who stutters and so she has begun to stutter herself. When at home she was very influenced by the personality of her father and assumed characteristics typical of her father. Therefore, it was felt unwise to keep her for long periods in a mental hospital with mentally disturbed patients who might themselves have a bad effect on her progressive advance towards mental health. It was thought that if she could have weekend leave she could react in a normal environment.
I understand that the girl's mother is a responsible woman who takes considerable care to follow the instructions of doctors. It was thought right to allow her to go home on weekend leave.
§ Dr. Winstanley
The Minister said that this action was taken because the consultant recommended it. Was the action taken on the advice of one consultant, or was any further opinion sought before a decision was taken?
§ Mr. Lyon
I was about to come to that. In all cases, both in special hospitals and also in National Health Service hospitals, the patient, as in every other medical case, is under the control of the consultant who is regarded as the responsible medical officer. But a consultant psychiatrist in a mental hospital as large as this hospital, containing 1,400 beds, has fellow consultants in the hospital and also junior consultants in his team. Inevitably these cases are discussed among a number of doctors. The indications of health are assessed by a number of people. The consultant acts and then the Home Office, on the advice he tenders on behalf of the team, will act. In this case we acted to allow home leaves in May.
I fully understand the stress on the parents of the girl who was killed and I can understand how they felt so soon after the event to see the girl in question walking in the street. Unfortunately, they came to know about the home leaves and as a result this matter was drawn to the 1699 attention of a Sunday newspaper, which played it up as a news story. The result has been to foment concern and agitation in the area represented by the hon. Gentleman. Not unnaturally, that has got back to the girl and there is no doubt that it has affected the otherwise steady progress she was making. It has thrown back her cure to some extent. She has had a relapse into the kind of hallucinations which she suffered at the time of the original trouble. With the aid of Modecate she is overcoming that and making progress again.
In due course it will be necessary to resume the planned programme of leaves to help her to recover her health completely. There is no question of releasing her yet. There never was a question of releasing her in the immediate future unconditionally. It will be some time before that decision will have to be considered. The visits home are simply a method of helping her to recover her health and one views them in that light. But if she continues to make progress the time will come when it will be right and proper to discharge her, and we intend that she should go back into the community.
In the light of my explanation, I hope that not only the hon. Gentleman but the parents of the child will feel that we have acted responsibly and that there was no mistake in this case. I hope too that it will be accepted that, although I understand their feelings, it would not be right to accede to those feelings in order to keep a person inside a mental hospital who properly ought to be allowed out at least on weekend leave and permanently in due course.
§ Dr. Winstanley
Before the hon. Gentleman finally concludes his remarks, may I put two matters to him? I should like to know whether, in the course of these visits, the services of the mental welfare authorities were alerted so as to assist the parents and the girl herself, and whether the same will be done on the occasion of future visits? Secondly, were conditions attached to the weekend leaves, and would similar conditions be applied if future weekend leaves were arranged?
§ Mr. Lyon
The conditions for leaves are set out by the consultant psychiatrist on the basis of his view about what seems appropriate for each patient. For the limited period that this girl was allowed leave—the nature of the medication that she was taking would last easily over a weekend—it was not considered necessary to have any social service back-up. If there was ever any question of discharge, we would make careful arrangements for social service back-up and perhaps probation office back-up to support the patient. In this case, as is normal, we warned the local police of what was happening. In any case, parents are always told to get in touch with the consultant at the hospital if there is any difficulty.
All these conditions were applied in this girl's case. The fact is that she did not prove a danger on the very few visits that she had at home. It is only the distress in the area which caused this setback and which prevented her from continuing the programme of leaves.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-two minutes past Ten o'clock.