HC Deb 24 June 1992 vol 210 cc359-66

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

10.13 pm
Mr. Tom Clarke (Monklands, West)

I first raised these matters on an Adjournment debate similarly entitled —[Interruption.]

Madam Speaker

Order. Would hon. Members leaving the Chamber do so quietly so that we can get on with our business?

Mr. Clarke

Thank you, Madam Speaker. I am sure that I shall be awarded injury time.

I am delighted to see that the Chancellor of the Exchequer and the Chancellor of the Duchy of Lancaster are present, as well as the Minister of State, Home Office, because the problems of mentally ill people in prison might be helped by their interest.

I first raised this matter in an Adjournment debate, similarly entitled "Mentally Handicapped and Mentally Ill Prisoners", on 16 July 1986. I should have liked to report that there has been more progress since then. However, as there has been no progress, there is need for this debate.

I had hoped for an Adjournment debate in February but, unfortunately, that was not possible. As the Minister knows, prior to that I had visited Brixton prison and saw some examples of dedication on the part of the staff, but also matters which I am sure will worry the House deeply and will help us to concentrate on the issues under discussion.

The governor of Brixton prison, Dr. Coyle, is extremely dedicated. Without dwelling on such important issues as F-wing and other aspects of psychiatric care, I thought it would be right to give a flavour of my visit by quoting a letter that the governor wrote to The Independent in response to some criticisms made last October, which I think were unreasonable. Two points in the governor's letter are well worth making. He said, first, in respect of his prison: For many years, in excess of 1,000 prisoners have been crammed into some 700 cells … Among this number of prisoners about 300 on any one day require medical supervision of one form or another. The vast majority has been remanded for psychiatric reports. That is the equivalent of a medium-sized psychiatric hospital. It is important to remember that Brixton is not a psychiatric hospital. Elsewhere in his letter Dr. Coyle wrote: In the past 12 months there have been two deaths by suicide in Brixton Prison. These are two too many but they have to be seen in context and comparisons can usefully be made with the experience in psychiatric hospitals similar in size to the medical wing at Brixton. During the same period staff have successfully intervened to prevent 38 prisoners taking their lives. That indicates a level of care of which Brixton can be proud. The governor was absolutely right. Sadly, many of the problems that he outlined are shared by other prisons and are worthy of our consideration.

The Minister will be aware of the Gunn report, which found that about one third of sample male prisoners and 59 per cent. of females were diagnosed as having some kind of psychiatric problem.

The review of health and social services for mentally disordered offenders and others requiring similar services, chaired by Dr. John Reed, also reported on various groups and their needs. We know that every person in those circumstances is unique, and is entitled to an individual assessment and to understanding of his or her problems.

The Gunn report was published in 1990 and revised in 1991. The Minister will be aware of its contents. I found that one of the most distressing points made in the report was: In some prison hospitals, it is possible to see an acutely psychotic patient locked in a cell for the whole day. He may be clad only in a canvas shirt with no possessions or furniture other than a mattress, possibly soaked in urine or soiled with excrement. Compulsory treatment can only be given in an emergency. Patients kept in such conditions in the health service would be the cause of public outcry and an inquiry. The situation is no more defensible when it occurs in prison. I entirely agree.

Of the Gunn report, The Guardian said: At least one in five sentenced prisoners is thought to have a mental disorder. A study funded by the Home Office and published in October put the incidence as high as 14,000 of the 38,000 sentenced prison population, with 1,100 so ill that they require immediate treatment. That is extremely worrying to the medical staff who seek to serve such prisoners, to voluntary organisations, and to the families of those individuals.

In December 1991, the Health Service Journal reported at length on the problem. I do not wish to weary the House by quoting exactly from that article, but it was interesting that it appeared under the heading "Prisoners who know not what they have done". The fact that there are people in prison experiencing enormous difficulties, who often are unable to cope with the environment in which they find themselves and who do not know why they are there, tells us a lot. Surely there must be better ways of dealing with such persons. I hope that the Minister can reassure us that the Government and their various Departments are at least aware that such problems exist in many prisons and not just in Brixton.

My worry is that, as I understand it, there has been no policy statement that explicitly covers the care and treatment of those in need of mental health care who remain in prison. However, the Government have published one document, to which I hope to refer. I am concerned about strategy and about the Government's approach to reducing the numbers and to coping with those who are in prison. Of course, it is increasingly accepted that too many mentally disordered and disturbed offenders are in prison who should not be there. However, there is no clear strategy across relevant Government Departments to ensure that services are available, and no single Department has lead responsibility for the care of mentally disturbed offenders.

If, as I understand it, the Government's policy is to reduce the number of such people coming into the criminal justice system, may I ask what is being done to achieve that end? How are such people being taken out of the system? Are they being dealt with in accordance with a proper assessment of the difficulties that they face? If the debate achieves nothing other than to obtain a clear statement from the Minister on the Government's approach to those important issues, its importance will be confirmed.

In preparing for the debate, I received a number of letters and representations from voluntary organisations. Colin MacKay, of the Scottish Society for the Mentally Handicapped, wrote to me, saying: There are no adequate alternatives to prison particularly for people with a mild or moderate handicap who persistently offend … The police have little training in mental handicap and may fail to recognise it, or not know what to do about it

There is a Scottish Office circular on interviewing mentally disordered suspects but it is a long way short of the more rigorous English Code of Practice under PACE (Police and Criminal Evidence Act).

Because of time constraints and the inadequacy of legal aid, defence lawyers may not pick up the fact that a person has a mental handicap. Clearly we are dispensing with the law in that case, to the detriment of vulnerable people who face those difficulties. I know that the Minister does not have specific responsibility for Scotland, but Scotland has that problem. He may wish to take that on board and discuss it with his colleagues at the Scottish Office.

How firm have the Government been in emphasising the powers available to the courts and other relevant agencies to divert mentally disturbed offenders from the criminal justice system, not just in England and Wales but also in Scotland? We must deal with what is often described as the "revolving door syndrome". Organisations such as MIND frequently refer to the problem in that way. Many prisoners are likely to be serving short sentences for petty offences and will not be subject to any statutory supervision by the probation service on release. Many may also be homeless and rootless. The Minsiter will know what the Butler report had to say on that as long ago as 1975. Although I recognise that the Home Office and the Mental Health Foundation funded the three NACRO diversion projects to encourage changes in current arrangements, I wish to ask genuinely what progress the Home Office feels is being made on those important points.

The Minister will acknowledge that the Government have had the benefit of a number of reports, not simply the views of voluntary organisations, important though they are, like NACRO, MIND and the Scottish Society for the Mentally Handicapped, but also their own Her Majesty's Chief Inspector of Prisons' report from January 1990 to March 1991, which said: It is our view that there is an urgent need for the Prison Service to review facilities for disabled and handicapped inmates, staff and visitors in all establishments. That was a profound comment, and when it is made at that level the House is entitled to hear of the response from the Home Office and other Departments involved.

There is also the report of the Reed committee. The Minister may wish to deal with that, but also with the representations made to his Department by MENCAP, MIND, the Patients Association, and many others who realise the importance of the issues raised.

The British Medical Journal expressed concern about such reports and what it considered to be elements of Government inaction when it, too, wrote an article headed, "Mentally disordered prisoners: reports but no improvements".

There is a real worry that, because the Government do not like information, we seem to be failing to get the response that the problems in those prisons, and of individuals in prisons, invite. The enormous strain on the prison medical service is self-evident. The whole House would wish to congratulate those who deal with such difficult issues. In November 1991, the Home Office published a consultation paper on the reform of the prison medical service. What will follow? What are the Government doing, given that the consultation document was published? What do they feel about the responses that they have received, and how much support are they giving to the prison medical service, which would be under enormous strain even if it were not for the problems of the large numbers of mentally ill or mentally handicapped persons who find themselves in prison?

The issues raised are particularly significant. We are concerned about the numbers of such people who find themselves in prison. We are also worried about the strain on, and demands made of, the staff, because clearly the management of such persons is out of all proportion to their numbers. I mentioned Brixton, but I think that suicide attempts occur elsewhere, which is why the rights of the individual have to be protected, and the Gunn report was based on the facts available to its author.

I shall put three specific questions to the Minister in the hope that, even if he cannot reply to them tonight, he will write to me with a considered response from the Home Office. According to The Independent on 1 June, £100 million is needed to support medical and nursing staff to meet the problems of mentally ill offenders. I do not know whether that figure is accurate, but I want to know whether the Government have made an assessment on resources and, if so, what conclusions they have reached.

Secondly, can the Minister tell us of the Home Office plans for pilot projects in the prison health service?

Thirdly, as we hear much about the privatisation of the prison service, and bearing in mind the vulnerable groups who are the subject of today's debate, it would not be unreasonable to ask whether the national health service will still be involved in the interests of such people. What are the Minister's thoughts on that matter, particularly in respect of mentally ill and mentally handicapped prisoners?

I thank the Minister for listening to my comments. Dr. Coyle, the governor of Brixton prison, said of the staff in prison who address the problems: There is a comradeship in adversity". I want that comradeship to continue, but the adversity should be reduced. Do the Government share those objectives?

10.32 pm
The Minister of State, Home Office (Mr. Peter Lloyd)

I congratulate the hon. Member for Monklands, West (Mr. Clarke) on his success in securing tonight's Adjournment debate to raise the important issue of mentally ill and mentally handicapped people in prison. Over the years he has demonstrated a sincere regard for the rights and circumstances of those who are mentally ill and mentally handicapped. His was a well-informed and thoughtful speech. I hope that what I say this evening in the time available will answer some of his worries and set out clearly our present practices and policies for the future. There will be some items that, in the time left me, I shall not be able to cover. I shall take up his request and write to him on those matters.

The issue of mentally disordered people in prison has recently rightly commanded much public and media attention. It is now widely understood that the imprisonment of a mentally disturbed offender can aggravate his or her mental disorder. It is the Government's policy that mentally disturbed offenders should receive care and treatment from the health and social services. They should be diverted from the criminal justice system at the earliest possible opportunity. The hon. Gentleman and I are agreed on that.

Mentally disordered people should he prosecuted, but only where that is required in the public interest. In other cases alternatives to prosecution should be found. To encourage that, the Government have issued guidance to the police, courts and the probation service, and are pursuing with the police ways of improving their working relationship with health and social services. Together with the Mental Health Foundation we have provided funding for three pilot projects organised by the National Association for the Care and Resettlement of Offenders to encourage the diversion of mentally disordered offenders from the criminal justice system. We are giving the foundation an annual grant of £250,000 to enable it to support diversion projects.

We are now also planning a series of regional conferences for senior managers and representatives of health and social services and the criminal justice agencies to help them to plan an improved response by their services to the needs of the mentally disordered who come before the courts. However, criminal offences are committed by people who suffer from mental disorder, and from time to time those people will inevitably find themselves before the courts. The courts should be guided by the provisions of the Mental Health Act 1983, which enables mentally disordered offenders to be directed away from prison.

To ensure that the provisions of that Act are fully understood and complied with, the Home Office issued detailed guidance in 1990. This drew to the attention of the courts and others the need to make greater use of their powers under the Mental Health Act. Those powers include the ability to remand a defendant to hospital for psychiatric reports. Persons remanded to prison or convicted prisoners may be transferred to hospital following medical reports that the individual concerned is suffering from mental disorder.

Furthermore, prison sentences for offenders who are mentally disordered at the time of their appearance in court may be avoided altogether if the court so decides, and the offender detained in hospital.

There has been a significant improvement in the number of prisoners transferred to hospital. During 1991, 470 prisoners were transferred under sections 47 and 48 of the Mental Health Act, compared with 325 in 1990 and 137 in 1986. This represents an increase over the past year of 45 per cent. and prison medical officers and Home Office officials are continuing their efforts to identify and transfer prisoners to hospital where appropriate. We expect to transfer at least 600 this year.

The policy is clear. Imprisonment is not appropriate for the mentally disordered. However, the Government are aware that, despite the improvements, there is still some way to go. There are still in our prisons some mentally disordered offenders who should be directed to hospital, and some who are mentally disordered but are not detainable under the Mental Health Act and cannot, therefore, be transferred to hospital solely because of that mental disorder. For this second group the commitment must be to provide adequate facilities and specialised care and support.

It was to assist us to establish the extent of this problem that we commissioned research from Professor John Gunn of the Institute of Psychiatry in 1988. This was one of the two reports to which the hon. Member for Monklands, West referred. The report was published last year and a copy is in the Library. Clearly, the hon. Gentleman has read it with care.

The report commented on the existing facilities for the treatment of mental disorder in prison, and made recommendations for improvement. We are giving careful consideration to Professor Gunn's recommendations and are in the process of developing a strategy for the care of those prisoners with mental health needs for whom transfer to hospital is not appropriate. A joint Home Office and Department of Health review of health and social services for mentally disordered offenders and others requiring similar services was announced by my hon. Friend the then Under-Secretary of State for Health in November 1990. The hon. Gentleman also referred to that report.

The steering committee of the review met at the beginning of 1991 under the chairmanship of Dr. John Reed, senior principal medical officer at the Department of Health, and has since been referred to as the Reed committee. It has to date made good progress and is due to end next month when the steering committee will submit a final report to Ministers.

The review has published eight interim reports, together with an overview document. These are the reports of the prisons, hospital and community advisory groups which were issued to interested bodies for consultation in November of last year, and they have elicited some 200 responses from a range of agencies.

On 2 June reports of the advisory groups concerned with finance, staffing and training, research, academic development and services for mentally disordered offenders with special needs were issued for consultation purposes. The advisory groups have made 87 recommendations that are intended to improve the co-ordination and delivery of care and treatment for mentally disordered offenders. These provide guidance on the range and magnitude of health and social services provision that may be required, as well as the systems necessary to identify and assess the needs of those who should be diverted from the criminal justice system to more suitable treatment centres. Several of the recommendations for the mental health care of mentally disordered prisoners are entirely in accord with proposals that are set out in the White Paper on the prison service entitled "Custody, Care and Justice" and in the recent consultation paper on contracting for prison health services.

The reports underwrite the Government's policy that mentally disordered offenders who need care and treatment should receive it from the health and social services rather than from the criminal justice system. It is not our intention that action should be delayed merely because the review is still taking place. Indeed, we are at present considering, with colleagues in the Department of Health, the present recommendations with the aim of identifying those that can be implemented at an early date. One such is the provision of additional beds in regional secure units. A further £18 million has been allocated to the building programme. This should ensure the provision of an extra 400 medium secure beds by the end of 1994.

The recommendations contained in the reports provide an opportunity to make radical improvements to the way in which mentally disordered offenders are treated in our society. As the hon. Gentleman implied, they have considerable resource implications. The cost of a bed for such transfers from the prison system to a local hospital could cost £30,000 to £40,000 a year. Transfer to a regional secure centre could cost upwards of £70,000 a year a bed. The cost of a bed in a special hospital would be similar. It is important that we get our plans right because they are certainly costly.

With the close co-operation that has been achieved between our Departments through the review I believe that we can develop a system whereby the mentally disordered should be cared for as far as possible in the community under conditions of no greater security than is justified and with the quality of care and attention that they require.

I intended to refer to several other matters but my time is limited. I shall deal, however, with the hon. Gentleman's question about the impact of the private management of prisons. I hope that in the end it will be small. I say that because I hope that we shall divert, before they get to prison, offenders who need treatment elsewhere. Should such offenders arrive in a prison, which will happen from time to time, the medical service in the prison—whether provided under contract by the national health service or by a private health provider—will operate in the same way as the rest of the prison service. It will diagnose those who should not be in prison and they will then be moved out of the prison service into an NHS institution—it will be an NHS institution for the foreseeable future. There will be no difference in approach between the privately managed prision and the public sector prison.

The hon. Gentleman referred to Brixton when talking about the need to give appropriate treatment. He is aware that we have been developing an acute psychiatric unit in Brixton that will provide a high standard of medical and nursing care and an improved regime for acutely disturbed inmates for whom transfer to hospital is not immediately possible or perhaps not necessary. The building works are completed and arrangements are in hand to select personnel who are qualified to staff the unit. The unit will be brought into use once the staff are in post.

I shall write to the hon. Gentleman about the matters that I have not had time to cover. I am glad that he has given me the opportunity to put on record what I have this evening because he has raised an important subject.

Question put and agreed to.

Adjourned accordingly at sixteen minutes to Eleven o'clock.