AFTER-CARE

HC Deb 18 October 1982 vol 29 cc157-63

Mr. Terry Davis

I beg to move amendment No. 99, in page 32, line 16, after 'Act,' insert 'or having been transferred to a hospital in pursuance of a transfer direction made under Section 72 or 73 of the principal Act,'. The amendment relates to clause 47, which has achieved fame in our deliberations because it was added to the Bill in the other place. I am not sure whether it was the only change made in the other place. It was certainly the most significant change and it was made against the Government's wishes. It was a clause about which we had some fears. The Government were tardy in giving assurances that they do not intend to seek the removal of this most important clause about after-care.

I appreciate that the Government maintain that clause 47 is unnecessary. However, it is a clause which is dear to the hearts of all Labour Members, and, I believe, to some Conservative Members. It provides that, if someone has been either detained under section 26 of the Mental Health Act 1959 or admitted to a hospital as a result of an order by a court under section 60 of the Mental Health Act 1959 in the circumstances that we were discussing earlier in relation to new clause 3, there would be a duty on the district health authority and the local social services department, in co-operation with voluntary agencies, to provide an after-care service for that person on his discharge from the hospital.

The unanimous view of the Opposition is that that clause is important because there have been grounds for criticism of the after-care services that have been provided in the past for people who have been discharged from hospital. It was an issue that was mentioned on Second Reading and several times in Committee. As has been said, it is nonsense for people to be discharged from hospital only to find that they are sleeping under bushes in the hospital grounds because they do not have anywhere else to go. There is a need for much more to be done in terms of care after people have been discharged from hospital.

As it stands, the clause refers only to people who have been either detained under section 26 or admitted to hospital as a result of a court order under section 60 of the principal Act. Amendment No. 99 would extend the provisions so that there would be a duty to provide aftercare for people who have been transferred to hospital from prison. That would include cases under sections 72 and 73 of the principal Act. There seems no good reason for leaving out patients who happen to have been in prison before they were admitted to hospital. The only difference would be between those who are admitted direct to hospitals under section 60 of the Mental Health Act 1959 and those who go into prison first and it takes time for places to be found for them in hospitals. Those people are covered by sections 72 and 73.

The Minister of State, Home Office, told us that he took great pleasure—indeed, we all do—in the number of people who have been transferred from prison to hospital because they need treatment which can be provided only in hospital, which is where they should be rather than in prison. Those people are also in need of care after their discharge from hospital.

As we understand it, clause 47 would not cover those people at the moment. We believe that there is no logical reason for that. We cannot understand why there was no reference to sections 72 and 73 in the clause as it was added to the Bill in the other place. Therefore, amendment No. 99 would include those two sections. I hope that the Government will accept the amendment.

I know that my hon. Friend the Member for Ipswich (Mr. Weetch) is anxious to contribute to our discussion on this matter, because he has a serious constituency concern.

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Mr. Ken Weetch (Ipswich)

I strongly support amendment No. 99. I do so for compelling constituency reasons. I have followed the argument on clause 47, which is the first provision in part VII and which concerns aftercare. The amendment refers to section 72 of the parent Act, the Mental Health Act 1959. Section 72 concerns Removal to hospital of persons serving sentences of imprisonment. I want to add for very violent crime". Section 72(1)(a)of the parent Act states: that the said person is suffering from mental illness, psychopathic disorder, subnormality or severe subnormality". I have followed the debates throughout. I followed the debate in the other place. I followed the Committee proceedings quite closely and I have read every word said on this matter. I was pleased to hear my hon. Friend the Member for Birmingham, Stechford (Mr. Davis) speak from the Oppos lion Front Bench. It is important that I should support the amendment because in July 1980. the son and daughter-in-law of two of my constituents were brutally murdered by someone with a history of chronic mental disturbance.

The details of the murder would make many people physically sick. Suffice it to say that when the judge passed sentence it was discribed as quite horrific. The criminal was described in the trial and elsewhere as schizophrenic and psychopathic, with a history of escalating, unpredictable and quite violent crime. He was convicted of manslaughter with diminished responsibility and sent to Rampton.

That conviction was the climax to a very long catalogue of crime. The matter involved the hon. Member for Brentwood and Ongar (Mr. McCrindle) more heavily than me, because the crime was committed in his constituency. However, it involved the son and daughter-in-law of two of my constituents. Those constituents live in the next road to me. I pay great tribute to the hon. Gentleman, who is in his place, for the way in which he took up the case and for his unremitting attempts to get satisfaction over matters relating to this issue. However, for the reasons that I have given, I am involved.

The circumstances of the case and the issues that arise are relevant to the clause and to the amendment. The principal points at issue are three in number. First, I am concerned about the relevance of a very violent criminal record that was related to a history of chronic mental disturbance. Given what happened, the 1959 Act proved ineffective. I am arguing in the hope that steps will be taken to ensure that that will not happen again.

Secondly, I am concerned about the whole question of after-care in the special case of violent criminals, particularly those with a history of mental disturbance, as well as the question of what happens after release from prison. Thirdly, and just as importantly, I am concerned about the safety of the community. All this is critically at issue, and is related to the amendment with particular reference to the inclusion of section 72 cases.

Mr. Kenneth Clarke

It may assist the hon. Gentleman in arguing his case if he knows, before he goes into the general principles underlying the argument, that I propose to accept the amendment on behalf of the Government. The hon. Gentleman is thus pushing at an open door, and may not need to push as forcefully as he might have been intending.

Mr. Weetch

I am pleased to hear that. I did not expect a victory that easily. I thank the Minister and accept my victory gratefully. I shall cut short what I have to say, but there are one or two other matters that I must put on record.

Professional judgments were involved in this case, as to whether a person should be let out into the community when there was a long history of violent crime. We all know the nature of professional judgments. A doctor can take the wrong leg off, and provided that one can argue that it was done in professional good faith, one is through the door. I have always been a little sceptical of arguments such as that.

The plain facts are these. From 1957 until 1981, a period of 25 years, the person who was convicted of this manslaughter had a criminal record of considerable length, that included everything on the calendar of crimes. There were a number of convictions for robbery with violence, malicious and malevolent knifings, which culminated in the horrific manslaughter I have described.

In 1967, the man stabbed a fellow prisoner and was transferred to Broadmoor. In 1970 there was a conviction for breaking and entering with assault. In 1974, he stabbed his wife in the back, and in 1977 there was a conviction before Lewes crown court for malicious wounding, where a knife was plunged to a depth of 10 inches, so that it disappeared into the victim's chest cavity. What I wanted to know, and what I still want to know, is how such a person as this, with a record of unpredictable violence, found his way into the community, after repeated periods of examination and treatment, so that that murder was committed. The crucial question, which I have had in my mind for a long time, is how the legislation before the House tightens the regulations, so that risks such as these, which culminated in so much grief, could be avoided.

The facts are significant. In connection with the first episode of violence, the offender was transferred—

Mr. Deputy Speaker

Order. It is not in order for the hon. Member to argue a specific case in a Bill of this kind. He must deal with the amendment.

Mr. Weetch

I shall attend to your guidance, Mr. Deputy Speaker. I was trying to show that here was a long history of violence, despite which, and despite the pile of evidence as big as a haystack, a decision was made to release this man into the community without provision of after-care.

The reason why I wish section 72 to be included in the framework of the Bill is that in this case, because there was no after-care, and this person had no one to report to and no treatment laid down for him, he was a walking murderer waiting for something to happen, and it did. That is very serious. This legislation should be tightened as far as possible to see that the community is protected. In emphasising the framework of after-care and the professional decisions associated with it, I hope to persuade the House that I make a serious point. I have sought to recite some details because this was one of the most horrific stabbing cases in the history of crime this century. That is its importance.

There was a repetition of events. When discharged, people, on occasion, wander around the community living under hedges, without treatment or supervision. That is when trouble occurs. The matter needs to be critically examined. I remain to be convinced—I shall be pleased to hear what the Minister has to say—that the House has achieved everything in the Bill as it stands to see that such situations do not recur. It is impossible to predict human nature but the fact that these crimes were unpredictable should have made everyone concerned to see that no chances were taken. When a catalogue of crime is part and parcel of a history associated with mental disturbance, the area for professional discretion should be very limited and the framework should be solid. To this end, I support the amendment and I am glad that it will be accepted.

Mr. Kenneth Clarke

The constituency case raised by the hon. Member for Ipswich (Mr. Weetch) is obviously distressing. The hon. Gentleman feels strongly about it. All hon. Members are appalled to hear that a patient with a history of mental disturbance and violent behaviour was released and committed an appalling crime against two of the hon. Gentleman's constituents in the constituency of my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle). Without further details, it is impossible for me to discuss the case of a particular individual. On the issue of Government responsibility, the sentencing decisions of the court are not subject to political review. I also suspect that the powers of the court and the treatment of offenders are matters for my right hon. Friend the Home Secretary rather than for my right hon. Friend the Secretary of State for Social Services and myself.

Nevertheless, it is plainly right, when discussing this Bill, that the hon. Member for Ipswich and everyone else should be reassured that the Mental Health Acts contain provisions, when used, to protect the public against the most dangerous and violent form of offender. The main protection for the public is provided by section 60 of the Mental Health Act 1959 which empowers a court to make a hospital order and the doctors to decide when the man is treated and when he can be released. Section 65 states that if it appears to the court, having regard to the nature of the offence, the antecedents of the offender and the risk of his committing further offences if set at large, that it is necessary for the protection of the public so to do, the court may, subject to the provisions of this section, further order that the offender shall be subject to the special restrictions set out in this section". Among the restrictions in the original Act of 1959 was that requiring that he should not be discharged without the consent of the Home Secretary as the Secretary of State exercising the powers. That is modified in the Bill, though not by the amendment. Clause 27 makes amendments to the law on restriction orders and restriction directions and enables mental health review tribunals to direct the discharge of patients subject to a section 65 order if they are satisfied, on the evidence, that they should be discharged. 2.15 am

Both measures, even as they are to be amended, mean that when someone who is plainly mentally ill and potentially dangerous to the public appears before the courts, they have adequate powers not only to make a hospital order, but to put restrictions on his discharge. The patient will not be discharged solely at the discretion of the doctors. Because the doctors have such difficult decisions to make in these cases where the risks are so great, a discharge has to be ordered by the Home Secretary or by the mental health review tribunals. That means that the Home Secretary and his advisers will assess and weigh up the evidence of the psychiatrists before they direct discharge or the mental health review tribunals will hear all the evidence and assess the psychiatric evidence before discharging such a patient.

We are giving that new power to the tribunals and because it is such a significant power there will be new appointments as chairmen of the tribunals. Senior judges—High Court judges with experience of the most serious criminal cases—will normally chair hearings when applications are made for the release of a restricted patient.

Mr. R. A. McCrindle (Brentwood and Ongar)

I understand all that my hon. and learned Friend has said and I appreciate that he does not wish to concentrate on the one case, but in the light of what he has said about the provisions of mental health legislation, does he not find it surprising that an individual with the record that the hon. Member for Ipswich (Mr. Weetch) has accurately outlined should ever have found himself back in the community?

Mr. Clarke

Everyone who heard the description of the case will find that surprising, but in defence of those involved—I have not identified the individuals and the case does not ring any bells in my memory—one must say that before coming to a considered judgment one would need to know the full particulars of the case and everything that was before the courts and the doctors who took the decisions. Secondly, these are desperately difficult decisions to make. In the immediate aftermath of such a crime it is tempting to argue that anyone with such a history should be locked up and the key thrown away, but speaker after speaker during proceedings on the Bill has argued for a liberalisation of the law because the civil liberties of those who are detained are not adequately protected, and it has been suggested that the Government are not going far enough in making sure that decisions to detain are reviewed properly and assessed by independent people.

I believe that we have struck the right balance. When appalling cases occur and homicidal, mentally deranged people who are a danger to the public are locked up in Broadmoor or Rampton, it can be desperately difficult to decide whether to release them. A young man may appear to be cured after a number of years and one cannot say that he should be confined for his natural life when no one can find any grounds for saying that he constitutes a danger. Yet one knows from experience that patients who have satisfied every psychiatrist that they are safe and, under the old law, have satisfied the Home Secretary that the psychiatrists are right, have been released and have committed the most appalling crimes. It will be no consolation to hon. Members or to the relatives of those who were killed in this case, but the number of cases where dreadful errors turn out to have been made is tiny. It is also a matter on which certainty of judgment is almost impossible, even by the most skilled psychiatrists, tribunal, Minister or officials. The law exists to provide safeguards, but they can never be perfect. In this Bill we have not weakened those safeguards.

The case of dangerous mentally ill offenders brings me back to the direct question asked by the hon. Member for Ipswich. Those offenders will not be released if the court has made a restriction order on the judgment of the professional psychiatrists alone. It would not be fair even to the psychiatrists to leave the matter to them alone. It would require the consent of the Home Secretary or the tribunal.

Mr. McCrindle

I accept all that the Minister said, and particularly the fact that, happily, the number of such people who are unleashed on society is very small, but does he now intend to turn his attention to the question asked by the hon. Member for Ipswich (Mr. Weetch) about after-care, or some continuing check on individuals who are allowed back into the community, so that some reassurance may be given to the public that such people are not simply released and that is the end of the story? That point put by the hon. Member for Ipswich seems almost as important in my view as the one to which the Minister has just addressed himself.

Mr. Clarke

I accept that, and the amendment that we are discussing is about after-care.

To answer my hon. Friend's question, I turn to the Bill and clause 47. There has been a continuing debate about whether clause 47 is strictly necessary. In the Government's opinion, satisfactory statutory duties are already laid on local authorities to provide after-care for discharged mental patients. Those statutory duties exist, are satisfactory, and certainly extend to discharged section 65 patients who represent a particularly important problem.

In the House of Lords, clause 47 was driven into the Bill, and there it remains. The Government's only objection to it in the first place was that it was unnecessary. It duplicates the existing statutory duties. If the House feels strongly that it wants belt and braces, there is no compelling ground for arguing against clause 47, in that it merely duplicates an existing statutory provision, and we all agree that we want the statutory duty to exist anyway. We have accepted clause 47, and we accept this amendment because this category of patients—patients transferred to hospital under section 72 or section 73--are indistinguishable in principle from, for instance, section 60 patients. This, therefore, corrects a drafting anomaly and should be added.

I want to make it clear that for restricted patients under section 65 or section 74 of the original Act—I imagine that that is the category of patients that are involved in the case that was given--there is provision for conditional discharge, which enables a discharge to be made, subject to conditions set down by the Home Secretary. It means that a patient is subject to recall to hospital if he does riot make satisfactory progress when he is first released. While the patient is conditionally discharged in that way, supervision is provided so that someone is aware if things are going wrong, and the patient can be recalled to hospital.

As I have said, I am happy to accept the amendment. It strengthens clause 47. If the House feels that it wants doubly to underline the statutory duties on local authorities, so be it. I shall not repeat the arguments that I used in Committee, when I said that the problem with after-care is not the statutory duty, but resources. Changing the law does not provide resources. If local authorities are endeavouring to meet a statutory duty within the resources that are available to them, they will not find it easier to discharge that duty if the duty is put on them twice and there is no change in the resources. The problem arises because of resources and there will be more appropriate occasions to debate that matter. I accept amendment No. 99.

Amendment agreed to.