§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Alan Howarth.]
§ 3.3 am
§ Mrs. Gillian Shephard (Norfolk, South-West)I am grateful for the opportunity to raise this matter, even at such an unsocial hour. My hon. Friend the Minister will recall the debate on prisons on 12 May. He will also recall that, although that debate was wide-ranging, the question of mentally disordered offenders in our prisons was not raised, although from time to time it appears in parliamentary questions, and two years ago it was raised in an Adjournment debate.
This morning I shall not explore the inadequacy of our prison system to deal with the mentally disordered offender—although that is riot in dispute—nor do I wish to complain about the lack of alternatives for such people. Rather I wish to ask how it is, given the legal framework provided by the Mental Health Act 1983, that any offenders with a mental disorder as defined under the Act are in our prisons.
The Government are to be congratulated on their ambitious building and refurbishing programme for prisons. There has been a 117 per cent. increase in capital expenditure on prisons since 1979. By the mid-1990s we shall have 26 new prisons. At the prison in my constituency at Wayland near Watton, which is a new prison, the work being done demonstrates what a difference it can make to prisoners and staff to work in up-to-date surroundings.
It is true that our prison population is among the highest in developed countries. However, the Government have been energetic in pursuing alternatives to custody while balancing those with the proper public concern about safety and security in the light of increasing numbers of crimes of violence.
Despite those achievements, the prison service is under strain. The conditions in which some prisoners have to live are unacceptable by any standards and our prisons are peculiarly illequipped to deal with mentally disordered offenders. What is more, they and the staff could do without the additional problems created by the presence of such offenders. Therefore, it is all the more curious that there should have been as many as 315 mentally disordered offenders, as defined by the Mental Health Act 1983, in our prisons on the last date of counting, which was 30 September 1986, when a perfectly satisfactory legal framework exists to prevent their admission in the first place.
Apart from the additional strain imposed on the prison service by the presence of those offenders, conditions in prisons are not likely to help their illness. The Select Committee on Social Services found in 1986 that prison medical officers prepared for the courts in 15 months more than 9,000 psychiatric reports, compared with 219 physical health reports on people remanded in custody for medical assessment. Only 40 per cent. of prison medical officers have a qualification in psychiatry. Therefore, some psychiatric reports are prepared by people who are not psychiatrists. It is clearly of the utmost importance that court reports should be capable of giving good professional advice on whether a person should be sent to prison or dealt with through the hospital or probation systems.
531 There are far more mentally disordered people in our prisons than those defined as treatable under the Mental Health Act. The report of the Select Committee on Social Services suggested that there could be as many as 1,500 male prisoners suffering from a mental disorder. That figure does not necessarily include those who become disordered after admission.
The treatment available to those offenders is restricted by the prison environment and by the availability of appropriately trained staff. There are considerable problems surrounding the issues of consent to treatment. Prisoners remanded to hospital under section 36 of the Mental Health Act are subject to the consent to treatment provisions contained in section 58. Prisoners in prison are not, with the result that those who administer medication have to rely on the common law for their justification and the prisoner has no rights at all. There can be no doubt that prison medical officers are under pressure to tranquillise a difficult patient, even without his consent, when the alternative is a prison for the disturbed. That is fair on neither the doctor nor prisoner.
If conditions in prisons are so unsatisfactory for those suffering from a mental disorder and if their presence places an additional strain on a system which, for the moment, is somewhat overburdened, why are they admitted in the first place? Some would suggest a lack of alternative placements but I would not. Thirteen of the 14 regional health authorities have permanent regional secure units. The remaining region, South West Thames, proposes RSU provision which is to function in association with several "close supervision" units already operating in existing hospitals.
Although this is primarily a matter for the Department of Health and Social Security it obviously impinges on the prison service and the offenders to whom I am referring. The use to which the RSUs are put, the admission criteria and the local co-operation and co-ordination between all the relevant agencies, particularly the consultant psychiatrist responsible for the RSU, are more important than the number of places available. However, that too is being watched by the DHSS, which is awaiting the results of a research study on the eventual national need for such secure accommodation.
In Norfolk, we have the East Anglian regional secure unit based at Thorpe St. Andrew near Norwich. It has 36 beds but, interestingly enough, for the first 18 months or so of the unit's existence, only 16 of them were occupied. Not only was that clearly very wasteful of the overall investment, it did not allow the unit to function as intended.
Fortunately, the regional health authority medical officer was able to ensure that occupancy rates became more realistic, and the unit is at last performing the task for which it was built at huge expense. However, what happened in Norfolk may well be replicated elsewhere in the country.
I would not agree with those who argue that special hospitals need more finance. There has been considerable investment in such hospitals in recent years, not least at Broadmoor, where a completely new building is being provided right now. More important than providing yet more money for special hospitals is the minimising of 532 delays for those awaiting transfer from prison, and that means speeding up the provision of reports and other admission procedures.
Given that our prisons are already under strain—for the moment anyway—and are not equipped with either the buildings or the staff to deal with mentally disordered offenders—and if alternative provision exists outside—why are 315 mentally disordered people, as defined under the Act, in the prison system? I suggest that it is because, despite the legal framework that exists to prevent it, there is still an imperfect understanding on the part of the courts of the alternatives available to them, and an imperfect relationship at local level between the judiciary, the penal system and the Health Service which, if it were used properly, could ensure a better use of facilities and a better disposal for the individual. Unfortunately for the moment, that arrangement does not function correctly.
The second biennial report of the Mental Health Act Commission, published last autumn, makes some interesting points. The commission set itself the task of collecting basic data that would give a broad indication of the level of achievement in practice of sections 35 to 38 of the 1983 Act, which provided that offenders who were thought to be, or had been judged to be, mentally disordered should not be held in prison. The commission was particularly interested in the extent of the use of section 35, which gives the power for remand to hospital for report to be used when remand on bail is felt to be inappropriate.
Two projects were set up. One in a Crown court division fell by the wayside because of the small number of returns made. The other was conducted with all the 314 magistrates' courts in England and Wales. Its aim was to chart the progress of defendants remanded for psychiatric reports from remand to final disposal over a three-month period. Returns were made on 241 cases. In 41 of those cases, despite the fact that the offenders could have been remanded to hospital for psychiatric reports, they were remanded in custody. Twelve per cent. were remanded to hospital as a condition of bail and only 11 per cent. were remanded to hospital under section 35; 36 per cent. got unconditional bail.
Given the high hopes attached to that part of the Act when it came into force, those figures are disappointing by anyone's standards. They may be explained by a variety of factors. Lack of familiarity with the provisions of the Act on the part of the courts looms large among them. Another is reluctance on the part of doctors to accept remands under section 35, possibly because such patients are also subject to common law principles on consent for treatment.
What happened to the 99—the 41 per cent.—who were first remanded in custody? Of those, 32 received hospital orders under section 37; two received interim hospital orders under section 38; 17 were imprisoned; and 48 received non-custodial sentences. The point about those figures is that during that period our prison service was burdened with a further 99 offenders all of whom might have been remanded to hospital under section 35 for report, and of whom a third ended up in hospital in any case, and half got non-custodial sentences. Of the 26 who were remanded under section 35, 15 got hospital orders under section 37 and nine got non-custodial sentences, which suggests that in their cases the use of section 35 was the right disposal.
533 I know that there has been a joint Home Office-DHSS working group, which reported last autumn to Ministers on some of these questions, and that the Government accepted all the 16 recommendations. I would particularly welcome information from my hon. Friend the Minister about the exact ways in which at local level, both magistrates and Crown courts and their officials are being made aware of their powers under sections 35 to 38 of the Act, and what effect this has had in the past six months on reducing the number of mentally disordered offenders in our prisons.
I should be grateful for any information on progress to encourage co-operation between judicial, penal and health services at local level, and the kind of information now required by courts about the availability of beds and so on. My hon. Friend will be familiar with the recommendation of the commission that more consideration be given to sections 35 and 36 with a view to giving a single power for both reports and treatment.
Our prisons have problems. Given that the Government are making such vigorous efforts to overcome them and that the 1983 Act is Government legislation, it is the Government's responsibility to ensure that the success of the one programme is not jeopardised by less than satisfactory functioning at local level of the other.
§ Mr. Patrick Thompson (Norwich, North)I am grateful to my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) for allowing me to intervene briefly. I wholeheartedly support her arguments. Clearly, prison is not the right place for many categories of mentally ill offenders, particularly schizophrenics.
My hon. Friend referred to the East Anglian regional secure unit, which is in my constituency. I have experience of, and have had talks about, what happens in Norwich prison. Many problems there serve only to underline what my hon. Friend has said. Recently, we have had suicides in prisons in the United Kingdom which also serve to underline the seriousness of this issue. I welcome the Home Office guidelines which were detailed in a written reply to me some months ago.
I should like briefly to draw attention to the work of the National Schizophrenia Fellowship both nationally and in Norwich in supporting families and campaigning on these issues. My hon. Friend referred to sections 35 to 39 of the Mental Health Act 1983. We may have to go further than she has suggested and amend the legislation so that health authorities cannot escape their obligations so easily and so that mentally ill patients are kept out of our often overcrowded prisons.
The continuing closure of our large mental hospitals is undoubtedly exacerbating this problem. I hope that my hon. Friend the Minister will talk urgently with colleagues in the DHSS about that matter and the other points that we have raised.
§ The Parliamentary Under-Secretary of State for the Home Department (Mr. Douglas Hogg)I am very grateful to my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) for giving the House this opportunity to discuss the treatment of the mentally disturbed individuals who come before the courts. If I may say so, she has 534 reviewed the problems with considerable clarity and is right to stress that the prison environment is not an appropriate place for keeping mentally disordered people. I suspect that her analysis of the reasons why there are in the prison system as convicted persons a number of mentally disordered people is, broadly speaking, correct.
There is no doubt that this is an important issue which causes the Government considerable anxiety. The House will be aware that my right hon. Friends the Home Secretary and the Secretary of State for Social Services set up in 1986 an interdepartmental working group on mentally disturbed offenders. It reported last year, and all its substantial recommendations were accepted by the Government. I am glad to say that good headway is being made with implementation of those recommendations.
My hon. Friend has asked me a number of specific questions. At the moment I am not in a position to answer them in the detail that she would like. For some time past I have been concerned with this issue. I am now trying to draw up for my own purposes a schedule of the sort of issues that the Home Office and the DHSS need to address, with a view to determining how we can reduce the number of mentally disordered people in the prison service. When I have had a chance to review the options I shall be in a better position to answer the sort of questions that my hon. Friend has asked tonight. I hope she will forgive me for saying that I find it difficult at this stage to give the sort of conclusive view that she wants. She has anticipated my deliberations by some weeks.
It is important to recognise that there is no single category of mentally disordered offenders. There is a complex group of people with differing medical conditions and varying needs for treatment, care and control. We must also recognise that psychiatric medicine is going through a period of fundamental change. Professional attitudes towards the way in which patients should be treated have changed profoundly. Change on this scale is bound to cause strains and dislocation.
An important distinction has to be made between people whose mental disorder falls within the scope of the Mental Health Act 1983 and who consequently may be detained in hospital for treatment, and those who, while they are mentally disordered. do not suffer to a degree that warrants their detention in hospital. These are separate groups, and we need to examine their problems individually.
People whose mental disorder brings them within the scope of the Mental Health Act can be dealt with in a variety of ways. Section 136 authorises the police to take them to hospital for assessment if they are found in a public place and appear to be in need of care or control. That applies whether or not they have committed an offence, and is a useful way of enabling the police to divert minor offenders from the courts.
I suspect that the police do not make sufficient use of this power. I also suspect that too often people are brought before the courts for relatively minor offences when they could be dealt with under the section to which I have referred. I should like the police to consider using that section more frequently.
When the police and the Crown prosecution service believe it is in the public interest to proceed with a prosecution, the courts have a number of powers available to them. Courts wishing to obtain psychiatric reports on defendants do not, of course, have to rely on the provisions of the Mental Health Act as an alternative to 535 remanding them in custody. In some instances, it may be possible to adjourn and ask a social worker or the police to take the defendant to a hospital. In others, it may be possible to grant him bail either on the understanding that he will seek medical treatment or on condition that he resides in hospital for such treatment.
Section 35 of the 1983 Act is also available to magistrates and Crown courts which want reports on the accused's mental condition. This requires the written or oral evidence of a medical practitioner that there is reason to suspect that the defendant is suffering from one of the four categories of mental disorder specified by the Act. The remand may be for 28 days at a time, with a maximum of 12 weeks.
Section 36 of the 1983 Act enables Crown courts to remand an accused person to hospital for treatment on the written or oral evidence of medical practitioners that he is suffering from mental illness or severe mental impairment of a nature or degree which makes it appropriate for him to be detained in hospital. The remand may again be for a period of 28 days at a time with a maximum of 12 weeks.
When a defendant who comes within the scope of the Mental Health Act has been convicted of an imprisonable offence, Crown courts and magistrates courts can make a hospital order under section 37 of the Act. Before doing so, they must have written or oral evidence from two medical practitioners that the offender is suffering from one of the four categories of disorder of a nature or degree that makes it appropriate for him to be detained in hospital for medical treatment.
My hon. Friend has emphasised the number of people who are in prison and who, in the view of the prison medical service, are such that they should be detained in hospital for treatment, and she has stated the numbers correctly. The last census in September 1987 showed that 188 remand prisoners and 156 sentenced prisoners fell into that category. The distinction must be made between remand and sentenced prisoners for these purposes. The remand prisoners are generally those who are awaiting assessment by doctors from the special hospitals or from the NHS to arrange for their admission if courts make hospital orders following conviction. I would like to see greater use made by the courts of arrangements such as remands direct to hospital, or of informal arrangements with local hospitals so as to reduce the number of people remanded to prison.
It is inevitable that there will be in prison on remand at any time a number of people who are mentally disordered within the meaning of the Act, and who are susceptible to treatment in hospital, but who, because of the court's 536 order, have to be in prison or on remand pending assessment. I do not find that quite as troubling as the number of sentenced prisoners in prisons.
We must accept that in some cases, especially the more serious ones, remand to prisons, at least initially, cannot be avoided. The prison medical service provides an essential service in liaising with the special hospitals and the NHS to make arrangements for admissions to hospitals either on transfer under section 48 of the Mental Health Act or after conviction.
I hope that the House accepts that the problem of mentally disordered offenders is one which the Government take very seriously. There has been a steady improvement in the facilities available in the special hospitals and in the NHS for people who can be detained in hospital for treatment. The 1983 Act introduced a number of measures designed to avoid the use of custody for mentally disordered people, including the power to remand for reports and treatment under sections 35 and 36 of the Act. It also enables the courts to make guardianship orders or to make interim hospital orders to enable a person's response to treatment to be assessed before the courts make a final decision. The Act has therefore given the courts a great deal of help towards enabling them to get mentally disturbed offenders into hospital care instead of into prison.
We recognise that much more needs to be done and this led us to set up in 1986 the interdepartmental working group, which involved work between the Home Office and the DHSS and, as I have already stated, the Government have accepted the great majority of the substantial recommendations, which we are now putting in place.
My hon. Friend has raised a very serious point, because there are a number—not a huge number—of mentally disordered people in the prison system. Many people suffer from mental handicap of a different kind, but that is a different problem. We are talking about mentally disordered people within the meaning of the Act, and there are too many of those.
The presence of the remand prisoners is probably inevitable, and I am troubled rather more by the presence of the sentenced prisoners. We must identify where it is that either the substantive law or the way that we implement the law is failing to prevent the entry into the prison system of such people. I propose to try with officials and, if necessary, with Ministers to identify such points and discover if there are a range of measures that we could introduce that would reduce the number of such persons in prison. As my hon. Friend has made her interest clear, I will do my utmost to involve her in the work that I should like to see carried forward.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Three o'clock.