Miss Beverley Channing (Hansard, 8 March 1985)

§ Miss Janet Fookes (Plymouth, Drake)

I rise to draw the attention of the House to the plight of a young Plymouth girl, Miss Beverley Channing, and, I hope, co illustrate the need for better facilities for girls, or men, who find themselves in similar circumstances. Her plight was recently highlighted by the well-known television programme "That's Life". I gave background information to the programme on the strength of several years' acquaintance with the problem and increasing frustration at the inability to deal with it. It was Lord Elton, in a letter on the subject to me in the autumn of last year, who rightly described the case as one which falls so awkwardly between the hospital and prison systems. I shall briefly outline the circumstances. Beverley Channing is now a young woman in her early 20s, the adopted child of Mr. and Mrs. Channing. It was observed that her behaviour was becoming difficult in her early teens. It may go further back, but it was certainly from adolescence onwards. Most laymen would now describe her behaviour as antisocial; not wicked, but more akin to the uncontrolled naughtiness of a child. Her intelligence quotient is good and goes far beyond that of a child, but she suffers from tantrums, which will sometimes cause her to strike out with her fists. On a number of occasions she has been known to set fire to things, not with the dedicated evil of an arsonist, but more out of what appears to be temper and spite, and in a way which so far has not caused any damage or harm to anyone. She has been known to break windows in the course of this antisocial behaviour, and on occasions her personal habits are unpleasant.

All this behaviour has led to a miserable cycle of appearances before the magistrates courts and periods of imprisonment when the magistrates have not known what else to do with her. As the result of co-operation between various authorities, she was put into a private hospital, St. Andrew's, in Northampton for a time. Unfortunately, although this was done with the best of intentions and was a costly undertaking, her behaviour showed no real signs of improvement. Some feel that her condition deteriorated, but that is a matter of some controversy. There was certainly no marked improvement.

Therefore, she was removed from hospital and she has been a voluntary patient at the local psychiatric hospital, Moorhaven, under the care of one of the consultants, Dr. Poole. On occasions, Beverley walks out of hospital and often sleeps rough. I fear that sometimes she has been taken advantage of by men seeking sexual favours, a most disturbing aspect of the case. Various temporary arrangements have been made for her. At the moment she is going by day to what is called in Plymouth the Monday club, which has no connection with the more famous one, but is intended for the unemployed. She goes to a night shelter. At least, a bed is available for her at a night shelter in Plymouth, though she does not always take advantage of it.

I have the impression that her physical health is now deteriorating, and I feel extremely anxious for her both in the short term and longer term if a better solution is not found. The real problem in a sense is that she does not fit into any category, as Lord Elton wisely observed.

1353 She has been the subject of diagnosis by no fewer than five psychiatrists. All of them—this is amazing when dealing with experts—agree that she is not suffering from a mental illness in the terms of the Mental Health Act 1983. She cannot, therefore, lawfully be detained under any section of that Act. They agree, however, that she has what they term a personality disorder; I suppose we would call it bad and unstable behaviour. That means that it is difficult, without her co-operation, to make any long-term arrangement for her.

I pay tribute to all those who have tried to help her. I cannot fault any of them. Those in the probation service, magistrates court, police, social services and the psychiatrists have all done their best according to their lights. Indeed, they have bent over backwards to be of assistance. The fact remains that her case is intractable.

It is interesting to note that a recent report by the Select Committee on Social Services entitled "Community Care" pinpointed the general problem. I appreciate that the Committee was speaking of cases much wider than that of Beverley Channing, but its report stated: Twenty-five years after the 1959 Act, informed opinion is slowly returning to the idea that there will always be a substantial number of mentally disabled people who are entitled to some sort of protection and support which may involve their partial withdrawal from the rest of the community. That sums up Beverley's case.

I should like to see some sort of halfway house, a special type of hostel, geared to the needs of such extremely difficult people where a stable background, but with a degree of compulsion, could be created for them. I would see this compulsion perhaps in the form of a probation order of greater length than one would usually expect, with attached to it a requirement that the person remains in the care of the hostel.

The only alternative which could have merit, if only she could be found, would be one of those special breed of landladies with a kind and caring, yet firm, approach, who would be able to provide for the physical needs of the person and at the same time give support. That would be something on the lines of the fostering of difficult children, which has been pioneered by a few local authorities.

One or the other of those would seem suitable. However, the backing of some compulsion is needed. I do not for a moment suggest that Beverley requires to be locked up in the old sense of the term for an indefinite period. Something in between is needed.

I realise that to suggest a hostel for one would be ludicrous. I understand, however, that there are others of a similar character to Beverley. My hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) has drawn my attention to a case which he believes to be very similar indeed to that of Beverley and which is causing him concern.

I have received three letters following the television programme outlining cases which seem to be very similar. The research section of the programme has told me of at least eight other cases—there are about a dozen more—and has sent me details of those eight. I should point out that Miss Esther Rantzen has told me that the research section has not had a chance to carry out a thorough investigation to find out whether those cases are precisely in parallel, but at least there is a prima facie case that there are other people in a similar position.

1354 Even if there are only a handful of people throughout the country who are in this situation, they pose a problem which causes endless anxiety to the authorities, whether they be magistrates, social workers, psychiatrists or the like. The impact upon the families of these people can be absolutely tragic. One only has to talk to these families or read the letters that they have written to understand very clearly the cost to and, indeed, the ruination of the lives of those who are most closely associated with these people.

I cannot, of course, give details of the other cases, because they must remain confidential. However, I am sure that arrangements could be made, with the permission of those concerned, for the details to be sent to my hon. Friend if he felt that it would be helpful to have them.

I have sought to point out what I believe to be a most worrying gap in the provision that we make for a small group of people. I look to my hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security to provide a constructive and much-needed reply.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

I can well understand why my hon. Friend the Member for Plymouth, Drake (Miss Fookes) has raised this issue as the subject of this afternoon's Adjournment debate. The circumstances surrounding the young woman concerned and her family have been of considerable local interest for quite a long time. In her turn, I know that my hon. Friend has taken a considerable interest in this case as the Member of Parliament for the constituency in which this young woman lives. Both the local interest and the interest of my hon. Friend has been reflected in the BBC television programme "That's Life", which was broadcast at the end of February. Everything that my hon. Friend has said this afternoon and the work she has already done on behalf of this young woman shows that my hon. Friend has her interests very much at heart and that she is also concerned about the effects upon her family. Families are very important in cases of this kind.

The individual case has been given a wider context by the publication of the Social Services Committee report on community care for mentally handicapped and mentally ill people. This is certainly not the occasion to try to respond to that very thorough and valuable report. However, I must say in passing that it seems to me that much of the publicity so far has not done that all-party report much justice either.

I do not want to dwell at length on the details of Miss Channing's personal history. My hon. Friend has said most of what needs to be said. I think my hon. Friend is looking to me to comment on services and policies and upon what we might do in the future to try to improve those services and policies. My hon. Friend illustrated two clear ways in which we could properly develop our policies and hence our services. I am grateful to her for doing so. The points that she made were very thought-provoking. I believe that my hon. Friend wants me to deal with them rather than to look in any greater detail at the case history of someone who, thus far, has had more than her fair share of personal problems and who probably deserves as much privacy as she needs increased help.

I am sure that most hon. Members would hate to have their case notes read out in public. My hon. Friend has reminded the House of details which have been public 1355 knowledge for many years. However, I wish to direct the attention of the House to a slightly wider way in which the Channing case can be viewed.

Doctors, the media and politicians should pause and consider the extent to which we should reveal personal details of individual patients with mental or physical problems or a combination of both. Important ethical issues have begun to emerge in the past year or two. I refer not so much to this case as to others which, prima facie, seem to involve the revelation of details about patients suffering from kidney failure or allegedly suffering from AIDS. The details have been gratuitously and easily made known to the public in a way that would never have occurred two years ago. We need to think very hard about exactly where the line should be drawn and how to achieve a new consensus about the balance between the patients' interests and needs and the public's right to know. I hope that the debate started by my hon. Friend today will allow us to go some way further towards the achievement of that end.

My caution about publicising case histories does not mean that Miss Channing is someone about whom the DHSS "does not want to know"—far from it. My noble Friend Lord Glenarthur, the Under-Secretary of State, wants to know — and indeed knows — all that he can about every detail of Miss Channing's case. The doctors and health workers in Plymouth want to know everything possible about Miss Channing and her problems, and indeed they do know, as my hon. Friend the Member for Drake has so adequately illustrated.

The trouble is that, in cases of the type to which my hon. Friend has referred, knowledge does not always lead to solution or cure. Whether it be in relation to getting people off heroin or stopping the spread of AIDS, it is easy to say that we need more knowledge but very much harder to find a solution. Nevertheless, we wish to know all that we possibly can about this unfortunate young woman so that we can do all that we can to help her. I believe that we have all the knowledge we need, but finding a solution which takes account of the patient's needs, her civil rights and her right to privacy is very hard.

I enter one caveat. There are people — my hon. Friend is not one of them—who see the link between the services which might be able to provide help and the people who need that help as essentially a matter of locking people up in hospitals until they are "better", but that is certainly not my view. Those who commit offences and are convicted by the courts are, of course, subject to whatever constraints the courts impose on them. That is not for us to discuss or dispute. In addition, the Mental Health Act provides for the detention of patients. In that legislation Parliament went into considerable detail to spell out who could and could not be detained, in what circumstances and subject to what safeguards. I pay tribute again to the Social Services Committee for its very wise comments about the patient's rights. That is the other side of the coin.

I shall reveal nothing new about Miss Channing's case so as to respect her privacy, just as my hon. Friend the Member for Drake has done. It is clear that Miss Channing has had mental and behavioural problems of one kind or another at least since her early teens and my hon. Friend has suggested that the problem may go back even further. It is public knowledge that Miss Channing has had contact 1356 with the courts, the probation service, hospitals, community nurses and the generality of the Health Service.

All those services have experienced serious difficulties with her, but they have worked together to try to help her. I am glad that my hon. Friend paid compliments to those people, who work so hard in the NHS, and I am sure that they will be grateful to her. It was in the wake of a collective initiative involving a number of people from different services that Miss Channing spent some time being treated in a private specialist hospital, St. Andrew's, Northampton.

There was a collective review before she left St. Andrew's last year. Professional assessment concluded that she was not then detainable under the Mental Health Act. We must rely on professional and clinical judgment:. It is not for me, as a politician, or for anyone else to make ad hoc judgments about these cases. As my hon. Friend said, five specialists agreed that Miss Channing was not detainable. Such unanimity is not always apparent in these assessments.

Without detention, a patient can, of course, be admitted to hospital for treatment if the hospital thinks that it can help and if the patient is willing to let the staff try to help. It is a statement of the obvious to say that none of the treatment provided has had much lasting, positive effect in this case, though that is no criticism of those who have laboured hard and long to secure a better situation for Miss Channing.

Miss Channing is subject to a probation order, but both health and social services are in touch and are helping as best they can. My hon. Friend made some interesting points about the possibility of probation orders being extended and made more prescriptive. We shall have to ponder her ideas. I was also interested in her view that we should turn to some of the old school of landladies to help with such cases. The sort of landladies that my hon. Friend the Member for Lewisham, East (Mr. Moynihan), who is my PPS, and I remember from our university days could perhaps have had a formidable and salutary effect in this case.

Miss Channing attends a day centre or probation office and has the support of a trained psychiatric nurse. I wish to put the facts on the record. All the facilities have not helped to solve this young woman's problems, but they are available and are being given freely.

I wish to correct any impression that this is a simple case of someone wanting treatment and being denied it or of wanting a hospital place and being denied it. Social services and NHS support is available when required and the Moorhaven hospital staff, who do excellent work, are ready to try to help again and again, as they have tried on a number of occasions in the past. However, of course, they need the co-operation of Miss Channing, her parents, friends, and those who seek to support her.

Some have suggested in this case and previous similar cases that a special hospital place should be provided. That is a tricky issue, because admission to a special hospital requires both that the potential patient is detainable under the Mental Health Act and that he or she should present a danger which justifies that special security. Those are clear preconditions and we are told by clinical and professional advisers that neither condition is satisfied in Miss Channing's case. I am sure that no one would wish any person who did not satisfy those criteria to be gratuitously locked up.

1357 On more general issues of policy, my Department has been taking a special interest in the range of problems and people covered by the general description "hard to place or hard to help", in which category Miss Channing falls, at least for the moment.

Some of the individuals involved in the category of hard-to-place, hard-to-help are mentally ill. Some are mentally handicapped. Some are psychopathic. Some have behaviour disorders. Some seem to have mixed or uncertain characteristics. There is a whole range of problems facing a small group of people who desperately need our help and whom we must strive to help.

I am glad to say that there has been a lot of progress in various ways in the ability and the willingness of the service to help people with difficult problems. We have still some way to go before either systems or science provide us with the answer. However, I can give three assurances.

First, we in the Department and my noble Friend Lord Glenarthur, who has special responsibility for this area of policy, are working for further progress in service development, including bringing together different 1358 perceptions of the needs and different experiences of success or failure in meeting them, as well as reminding authorities of their existing responsibilities and resources—all set against a small number of cases which have to be dealt with.

Secondly, a range of services and people in them have tried over a long period to help Miss Channing and others like her. This slow progress has not been due to any lack of effort or lack of provision. It simply has not worked. In the real world, things do not always work very easily.

Thirdly, those willing to help Miss Channing and others like her are in touch with her now. They are willing to take further initiatives if they have her co-operation or if her condition becomes such that compulsory detention under the Mental Health Act turns out to be appropriate on clinical and professional advice.

I must thank my hon. Friend for her interest and for giving me the chance to explain the difficulties that I have attempted to outline. I am also grateful for her detailed and thought-provoking ideas, which I shall take away and discuss with my colleagues.