HC Deb 16 July 1986 vol 101 cc1146-54

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

1.22 am
Mr. Tom Clarke (Monklands, West)

I wish to raise a matter which I think is of considerable importance and which, as far as I know, has not been debated for some time. It might be of special interest this week as I understand that tomorrow an important Committee report on these matters is to be published. I therefore look forward to the Minister's response.

I recently visited Barlinnie prison in Glasgow. I know that some of the circumstances of the prison, if not of the visit, are known to my hon. Friend the Member for Glasgow, Provan (Mr. Brown), who I am delighted to see in his place. While I was there, I met and spoke to mentally handicapped and mentally ill persons who had been sent to that prison.

I should like to make it clear that the governor, Mr. Gallagher, the medical staff arid all of the personnel at the prison seemed to be doing their utmost to help the persons concerned and I would not wish to reflect on their dedication. I have not recently met anyone, whether the families of the persons concerned or those responsible for running prisons and those who have a general interest in these matters, who takes the view that that sort of person should be in Her Majesty's prisons.

Society punishes law breakers, but we ought not to punish sick people; we ought to try to heal them. I know that the House will note the concern of such organisations as the National Prisoners' movement, PROP, the Prison Officers Association and the Scottish Prison Officers Association. I was interested to read in The Scotsman this morning the words of Mr. John Renton, the spokesman for the Scottish Prison Officers Association, who said that Scotland's prisons are not geared up to treating disturbed or mentally handicapped prisoners, although they do their best with the resources available. He continued: Prisons do what they can to provide treatment, but they don't have the medical and nursing staff geared to the problem. I most certainly agree with that. This problem has United Kingdom implications and its dimensions go well beyond Scotland. It is not a new problem. Her Majesty's chief inspector of prisons has raised these matters on many occasions.

The report of 1984 said: In previous reports we have expressed our concern about the detention of mentally disordered offenders in prison, when what they need is treatment in an appropriate psychiatric institution. Prison medical officers have frequently told us that managing mentally ill offenders was the hardest part of their duties. Many governors expressed similar views. There may be room for argument over the number of those offenders who could be better cared for in a mental hospital, but there can be no doubt that many are inappropriately confined to prison. One of the difficulties we have in trying to establish the extent of the problems is to find out precisely how many people who are mentally handicapped or mentally ill are spending their time in prison. I do not necessarily criticise the present Government on this point, but I do believe that Governments should be much more forthcoming than they are in trying to make assessments and endeavouring to provide information to the House and the country as to how many people are in prisons when they are mentally handicapped or mentally ill and manifestly should be elsewhere in their own interest and in the interest of society.

I have seen great variations in the estimates. On 25 October 1985 the New Statesman suggested that about 23,000 of the prison population had some kind of mental problem. It said that from 14 per cent. to 45 per cent. of the prison population are said to be in those categories.

I was astonished to discover that the Scottish Home and Health Department says that no statistics of any sort on mentally handicapped or mentally ill prisoners are collected in Scotland. I hope that in due course that can be put right. In this respect, I welcome the presence of the hon. Member for Argyll and Bute (Mr. MacKay).

The BBC, in its "Newsnight" programme — I congratulate it most warmly—on 7 July presented what I thought was an excellent analysis of some of the problems in this area. The programme dealt mainly with the tragic case, which is probably well known to the Minister, of Russell Ramsdon who, before the completion of the video which was trying to cover and assess his problems, unfortunately committed suicide. Clearly, Russell Ramsdon should not have found himself in prison. I agree entirely with the BBC in its assertion.

In drawing the Minister's attention to the programme — I thank the BBC for giving me the transcript — I would like to say that there are at least three points about which I think the Minister may be interested in what "Newsnight" had to say, if only because it is relevant to the wider problems which I invite the House to consider. Incidentally, I had asked for an Adjournment debate for many weeks before the programme took place.

The "Newsnight" programme was introduced by Donald MacCormack, who said: This autumn an emergency working party, set up by the Home Office, will report on a mounting crisis in Britain's jails, where now more than fifteen hundred mentally ill offenders are serving sentences, some psychiatrists put this figure as high as fifteen thousand, a third of Britain's prison population. Twelve years ago the Butler Committee recommended that two thousand places in special hospitals called Regional Secure Units should be provided for these offenders, but today there are barely more than four hundred of them. Elsewhere in the programme there were comments which I think are worthy of the Minister's attention. Mr. Julian O'Halloran said: Since the 1950s the number of beds has halved in psychiatric hospitals, because of a policy of getting patients to live back in the community. But where have these mentally ill people really gone? Over the same period, the prison population has been rising remorselessly, it's now about double what it was thirty years ago. And suspicious doctors have noted an almost exact correlation between the two figures. Immediately that was said, Dr. Malcolm Weller said: It's almost a one to one relationship, that is for every patient who is discharged from hospital, there is a corresponding increase in the prison population. During the programme my hon. Friend the Member for Knowsley, North (Mr. Kilroy-Silk) — I think that the House recognises the excellent work which he has done in these matters—made an intervention which I consider to be worthy of repetition. He said: Successive governments have given something like £80 million to the 14 Regional Health Authorities, tied specifically to the provision of units providing services for mentally disabled patients. Today, over 12 years later, we have got 10 units with less than 400 beds, another two units to come into being in the next two years and a further two Regional Health Authorities, both of whom, Oxford and the South West Thames Regional Health Authority, have received millions of pounds of public money to provide the facility for some of the most disadvantaged, vulnerable and deprived of our fellow citizens, and neither of them have actually got a single brick built or established to build those units. It seems clear that somewhere along the way we are failing in the objectives that I think the House would want to set in seeking a solution to these problems.

When there was a debate in another place on these matters it was established clearly that there are departmental grey areas. I ask the Minister to address himself to these matters and to tell the House—if not tonight, I hope that he will do so in the not-too-distant future—the number of offenders that come within these categories and how many are occupying places in prison.

The Butler report on abnormal offenders recommended as far back as 1975 that 2,000 places should be made available at appropriate and special institutions in the regional secure units. All the evidence suggests — this was said recently in another place—that we have no more than 120 places along those lines. If that figure is not accurate, I am sure that the Minister will bring the House up to date. We are nowhere near the objective set by the Butler report in its recommendations.

I pay tribute to organisations such as MIND which have done so much work on these issues. In my opinion, MIND gave excellent evidence to the committee which considered these matters and which is, I understand, to report tomorrow. MIND takes the view—it is one that I share — that it would be a mistake not to grasp the nettle of integrating the prison medical service with the NHS in a meaningful manner. We are a long way from achieving any effective co-ordination of that sort. Without that, or something like it, nothing will really change for the mentally ill who are in prison.

Like MIND, I favour all attempts to divert mentally ill offenders from prison, but I cannot see that anything short of additional resources for the NHS to provide secure places and a new power for the courts to direct regional health authorities to provide treatment for mentally ill offenders will achieve the objective.

There is a need to review the law on mentally ill offenders. In the meantime, I ask the Minister what the Government are doing to try to cope with the problems and to anticipate additional problems which the prison authorities might have to face. There is a clear need within the prison service for more psychiatric facilities. Clearly, attitudes must also change dramatically before we can talk of ourselves as being a caring society in respect of the mentally disadvantaged. Not much has been achieved since the Butler report and even the May report when a chief inspector takes the view, as one did recently, that many mentally ill offenders are at present inappropriately confined to prison, when the director of the prison medical services has expressed his strong concern about these problems, and when the director general of the prison service describes overcrowding in prisons as an affront to any civilised society.

Obviously, prison is depressing enough for any person. To suffer mental illness is also a dreadful experience. But to ask people to endure both prison and mental illness or handicap is something which all hon. Members would deplore.

I invite the Minister to address himself to those problems and to give the House some assurance about resources and new progressive thinking, and, in particular, to tell us what the Government have in mind for providing the regional secure units which society feels is long overdue if we are to deal with those problems compassionately, reasonably, and urgently.

1.35 am
The Parliamentary Under-Secretary of State for the Home Department (Mr. David Mellor)

I am grateful to the hon. Member for Monklands, West (Mr. Clarke) for raising this issue. He has demonstrated through his private Member's Bill, which has now received the Royal Assent and become an Act, a deep regard for the rights and circumstances of disabled people, including those who may be mentally ill or mentally handicapped. His was a carefully prepared and considered speech and I wish to respond to it as thoroughly and helpfully as I can. I hope that the information that I have prepared will meet some of the points he raised. I assure him that I shall go through the debate later and if there are matters which I do not have a chance to deal with tonight, I shall write to him. I have also had the opportunity of talking to my hon. Friend the Member for Argyll and Bute (Mr. MacKay), who came to listen to the hon. Gentleman's speech, and he will write to the hon. Gentleman about the purely Scottish points, on which I am not competent to offer him advice.

Inevitably, serious issues arise when one considers whether mentally disordered people should under any circumstances be within the prison system. Even if it is accepted that they should, there will always be anxiety about the type of provision made for them. The hon. Gentleman made all those points in his speech.

We must start from the basic fact that some people who are mentally disordered commit criminal offences, and if they are brought to court, it is a matter for the court to weigh the relevant points at issue. That may include the protection of the public and the state of mind of the offender. The court must judge the most appropriate disposal. The courts will have cognisance of the provisions of the Mental Health Act 1983, which consolidated the law relating to mentally disordered people and made some significant changes.

There are two main issues. The first is the extent to which the operation of the Mental Health Act enables mentally disordered offenders to be directed away from prison. The second is whether mentally disordered people who are in prison, most of whom are not detainable under the Mental Health Act and cannot therefore be transferred to hospital solely on account of their mental state, receive adequate medical attention and support through the prison regime. Let me set out the Department's policies on these issues.

First, it is our policy to transfer out of prison into hospital as many mentally disordered offenders as possible who are detainable under the Mental Health Act 1983, while monitoring the extent to which various sections of the Act may be regarded as effective. Secondly, it is our policy to maintain a close liaison with the DHSS, the special hospitals and the psychiatric services, regarding the provision of sufficient hospital places. Thirdly, it is our policy to provide an appropriate regime for mentally disordered people who have to stay in the prison system.

It might be helpful to the House if I pointed to the most relevant parts of the Mental Health Act 1983. A substantial element in the prison population comprises defendants, both convicted and unconvicted, who are remanded in custody, often for medical reports. Many of those are mentally disordered. The best hope of making a significant impact on their number is by means of the alternative of remand to hospital under sections 35 and 36 of the Mental Health Act, which were innovations and were brought into force on 1 October 1984. Those sections give courts the power to remand to hospital for a report on the prisoner's mental condition or for treatment. Their use is governed by the requirement that the court should first have medical reports and the offer of a bed from a suitable hospital.

Section 47 of the Mental Health Act empowers the Home Secretary to transfer from prison to hospital any sentenced prisoner who is so mentally disordered that he could be compulsorily detained in a mental hospital if he were in the community. Such transfer can be made only when a hospital bed is available for the prisoner that offers an adequate degree of security and treatment appropriate to his medical condition. Prison sentences for offenders who are mentally disordered at the time of their appearance in court can be avoided altogether if the court so decides, and the offender can be made the subject of a hospital order under section 37 of the Act, provided that the court is satisfied on the evidence of two doctors that the offender is suffering from mental disorder of a nature or degree that makes it appropriate for him to be detained in a hospital for medical treatment—that is to say, he would be detainable, even if not an offender, in order to be transferred.

Mr. Tom Clarke

The Minister may intend to deal with this point later, but is he aware that often the courts simply do not know where to send an offender because there is not adequate accommodation or facilities that they believe to be in the best interests of the offender? Have not views along those lines been expressed to the Minister?

Mr. Mellor

Yes, and we have been pressing hard and providing resources to ensure that every area has a regional secure unit to relieve the burden. There was some delay earlier in providing those, which was the subject of representations by the Home Secretary. We hope that the framework has now been established so that courts can be properly advised by those who are there to help them make these difficult decisions and to ensure that facilities are available. We can never wholly guarantee that courts will have the facilities that they want; from time to time cases arise that show that courts do not feel that they have those facilities. However, with the network of regional secure units coming into place provision is certainly better than it was, although it falls short of what anyone would consider ideal. I think that that is the hon. Gentleman's point.

Under section 41 of the Act, a Crown court may also make a restriction order, if it considers it necessary for the protection of the public from serious harm. Again, such an order can be made only if a suitable hospital bed is available.

Every effort is made to ensure that any prisoner who is detainably mentally disordered is transferred to hospital for psychiatric treatment, in accordance with the policy of reducing the prison population by the removal of certain categories of offender who ought not to be in prison. In accordance with that policy, the hon. Gentleman will be pleased to hear that the number of prisoners transferred to hospital has been rising rapidly and the success rate in dealing with recommendations for such transfers is high. On 31 March 1986, the number of sentenced prisoners who were considered to be mentally disordered within the terms of the Mental Health Act 1983 stood at 124, the same as at March 1985. That was 23 higher than at September 1985, but significantly lower than the 347 of June 1979.

Before I refer to existing facilities within the prison system, I should like to make two points which, while I am sure the hon. Gentleman is aware of them, might be overlooked by others. The first is that the prison system is not an island, a kind of self-sufficient microcosm of the general community. There is a substantial degree of functional integration with the NHS and prison medical officers making ready use of NHS facilities, including the advice available from consultant psychiatrists.

Secondly, with a very few exceptional cases, for those people who commit criminal offences and get sent to prison, the system is most accurately seen in context as an interlude—albeit that for some this may be measurable in years—between their more substantive periods in the community. We are therefore debating the care and management of mentally disordered people who, because of the offences they have committed, are in prison transit. There is an important corollary to that view, which I shall touch on in a moment.

What of existing facilities within the prison system? They are highlighted by the regime at Grendon prison. There are also facilities in the hospital annexe at Wormwood Scrubs and at Glen Parva and Feltham youth custody centres. It is open to prison medical officers to refer suitable prisoners to those establishments. As the House will know, the entire activities at Grendon are directed to the treatment and personal development of prisoners with personality or psychopathic disorders. The regime is carefully monitored by a standing committee under the chairmanship of the director of the prison medical service.

A current development at Glen Parva is that two wards in the centre's hospital are being opened shortly to enable 20 youth custody trainees who are intellectually or socially handicapped to be given specialised care and support. These wards will be staffed jointly by discipline and hospital officers, under the supervision of the senior medical officer. The therapeutic unit at Parkhurst C wing, which was closed in 1979 following disturbances in a neighbouring part of the prison, reopened last December. That is further good news.

I should like to refer to the part played by staff who are of course the prime and indispensable facility. The doctor-patient relationship in prison is professionally analogous to that outside, and the medical treatment offered a prisoner is determined in each case by the clinical judgment of the individual doctor concerned. Unlike patients detained under the Mental Health Act, the prisoner is not obliged to accept that treatment, except in very special circumstances. Happily some 30 per cent. of full-time prison medical officers have psychiatric qualifications. They are assisted as necessary, as I have said, by visiting consultant psychiatrists. There are nearly 1,000 hospital officers, some 11 per cent. of whom have nursing qualifications, half of those psychiatric. Additionally, there are about 140 trained nurses. It is planned to increase that number over the coming years and to raise further the proportion with psychiatric qualifications.

Training provision is under continual review. In 1984, the Department increased from 13 to 24 weeks the length of training for hospital officers, using the whole of the additional time on instruction in nursing mentally disturbed prisoners. A talk by the president of MENCAP featured in a development seminar earlier this year for all principal and senior medical officers.

No reliable information has existed on the number of prisoners who cannot be transferred to hospital under the 1983 Act but who in varying degrees seem mentally disordered. I know that the hon. Gentleman is concerned about that. We are tackling this deficiency with a snapshot census taken by prison medical officers on the position as at 4 December 1985, and again on the position during October this year. Preliminary indications are that, of some 24,000 adult males serving six months and over, about 1,430 — or 6 per cent. — require specialised therapeutic facilities by reason of mental disorder or abnormality. Of course, about 230 are regarded as being mentally ill and 860 as having a personality disorder.

In the initial view of prison medical officers, about half of the 1,430 prisoners are regarded as being appropriately managed now. The same census suggests that of some 7,200 young males serving six months and over, about 320 require specialised therapeutic facilities, 17 are regarded as being mentally ill, and 242 are regarded as having a personality disorder. Again, prison doctors judged that about half were being appropriately managed at that time. Those two snapshots are intended for immediate management purposes. They will enable the director of prison medical services the better to assess the adequacy of current provision and to give consideration to the size, type and number of such further facilities as may be indicated, and to what additional resources might be involved.

Arrangements are also in hand for an academic research study to be undertaken by the Institute of Psychiatry. It is envisaged that this study, which is expected to start in the autumn and to take three years to complete, will objectively describe existing arrangements for the management of mentally disordered inmates, evaluate the effectiveness of those arrangements and identify where needs are not currently being met and the means by which they might be met.

I return to the important point of liaison with the Department of Health and Social Security. My noble Friend Lord Glenarthur, who is the Minister responsible for prisons, has in discussion with Lady Trumpington, his counterpart in that Department, jointly set up an interdepartmental working group to look into the problems asociated with mentally disordered offenders in the prison system. That group, which is being chaired by the director of prison medical services, will have in mind the desirability of minimising the numbers of such prisoners in the system and facilitating their management and treatment in the most appropriate circumstances, both while in custody and after. This working group will consider also the preparation for release and inmates' planned acceptance back into the community. I hope that I am putting across to the hon. Gentleman that much progress is being made.

The motivation and experience of many members of the prison service of all disciplines enable a good deal to be contributed to the compassionate care of the mentally disordered in their charge. I stress again that we make no assertion of satisfaction in respect of current provision and arrangements, but I hope that the positive stance of the Government is clearly signalled by the initiatives which we have taken to get a better measure of the task and to assess what improved arrangements are desirable, while not losing sight of the general pressures in the penal system and the inevitable constraints on resources.

Question put and agreed to.

Adjourned accordingly at ten minutes to Two o'clock.