HC Deb 18 January 1999 vol 323 cc550-2
3. Mr. David Hinchliffe (Wakefield)

What proposals he has to consult with ministerial colleagues in the Department of Health on introducing legislation relating to individuals with personality disorders. [64347]

The Secretary of State for the Home Department (Mr. Jack Straw)

Extensive consultation preceded the publication on 8 December by my right hon. Friend the Secretary of State for Health of the Government strategy,"Modernising Mental Health Services". That document explains that the Government are considering proposals to create a new form of reviewable detention for those people with a severe personality disorder who are considered to pose a grave risk to the public.


Will my right hon. Friend assure me that the Government recognise that under existing law it is not possible to detain for treatment patients who are deemed untreatable under the Mental Health (amendment) Act 1983? Will he assure me that the Government will not put pressure on the medical profession to detain for treatment people whom it deems untreatable? Will he set out the Government's thinking on resolving a gap in the law that has existed since the passage of the Mental Health Act 1959, more than 40 years ago, and say how the Government will act on this difficult matter?

Mr. Straw

Whether a patient comes within the terms of the Mental Health (amendment) Act 1983 is a matter for the medical practitioners concerned, not for Ministers.

We are entering into a dialogue with the psychiatric profession because, as I have indicated in earlier parliamentary replies, the practice has varied over time and between different forensic psychiatrists. I had a meeting about exactly that matter last week with the president of the Royal College of Psychiatrists, and we will continue that dialogue. It is my view, and that of my right hon. Friend the Secretary of State for Health, that the concept of untreatability is fundamentally antithetical to the whole philosophy of western science, as it tries to set in stone whether or not a particular patient is capable of treatment.

As to the future, my right hon. Friend the Secretary of State for Health has made it clear that alongside prison for those who are subject to a serious personality disorder and who commit offences, and hospital for those who are categorisable at the moment under the Mental Health Acts, we need a third approach, under which those who are suffering from severe personality disorders and who pose a grave risk to the public can be kept in securer conditions as long as they continue to pose that risk. There they may have treatment, if such treatment can be identified.

Mrs. Virginia Bottomley (South-West Surrey)

Following the question from the hon. Member for Wakefield (Mr. Hinchliffe), I am pleased to hear that the Home Secretary is now having dialogue with the leader of the psychiatrists after his somewhat sharp remarks about them in this place not so long ago. The National Association for the Care and Resettlement of Offenders report recommended a separate establishment, outside the health and prison institutions, for those with severe mental illness, and that was very much the recommendation of the Fallon report last week. That is an extremely costly proposal. In the meantime, the danger is that those complex, difficult and dangerous individuals will be shunted between health and prison institutions without practical action. What timetable can the Home Secretary offer us?

Mr. Straw

I agree with the right hon. Lady that this a complex matter. Although they are relatively few in number, those individuals pose great problems for the professions concerned—but, above all, they pose a serious risk to the public if they are left at large. We are working as quickly as we can on the development of the third service. To keep costs down, we are looking at ways in which the Prison Service and the secure hospitals can be used for part of the provision. I am sorry that I cannot give a precise date for implementation, but we are proceeding determinedly against a background where the original proposal for such provision was made in 1975, in the Butler report.

Mr. A. J. Beith (Berwick-upon-Tweed)

Is the Home Secretary aware that a few very dangerous people—who used to be known as psychopaths—will be released from prison eventually, unless a psychiatrist certifies that their condition could be alleviated, or prevented from deteriorating, by treatment? It is no use castigating psychiatrists, and asserting—as the Secretary of State for Health did last week—that they are refusing to certify simply so that they can avoid having to treat those people, when to make such a certification would be in defiance of the Mental Health Act 1959. Does the right hon. Gentleman recognise that, however fruitful his discussions are, there is a gap in the law that will have to be dealt with?

Mr. Straw

We are dealing with the matter, but I happen to believe that the remarks of my right hon. Friend the Secretary of State for Health were entirely justified. Moreover, a recent decision by the House of Lords Judicial Committee in the case of Reid made it clear that the current definition of treatability does not just include whether a potential patient is treatable by the medical profession, but can include whether, for example, they are susceptible to sex offender treatment programmes run by the Prison Service or to treatment by psychological and therapeutic services. I say again that we already know that the practice of medical practitioners in this field varies considerably. That justifies hon. Members on both sides of the House who are faced with a seriously disturbed offender—who, without almost any doubt, is likely to commit further offences—saying to the relevant medical practitioners, "Are you absolutely certain, within the law as it has been defined extensively by the courts, that this individual is not susceptible to any treatment of any kind?" That must be the question before such people are let out at large.

Mr. John Greenway (Ryedale)

The Home Secretary is right, but is there not a very wide range of individuals with personality disorders? Some disorders are much milder and are treatable. If we are serious about reducing the prison population, we must take on board the fact that some people with a personality disorder that could and should have been treated need never have ended up in prison. If there is a scandal in this, it is the fact that so many young people who go out of the control of the Department of Health because of age are left with no one to care for them. It is scandalous that some psychiatrists say that they are not treatable, when the majority view is that they are.

The Home Secretary knows of my great interest in this issue. Will he press his colleagues in the Department of Health to introduce mental health reform legislation at the earliest opportunity? The Minister of State may shake his head, but there is some talk about the next Queen's Speech and the matter is urgent. I hope that mental health reform measures would command the full consensus of the House.

Mr. Straw

I am grateful to the hon. Gentleman, and I know of his great interest in this subject. I am sure that most Members of Parliament would subscribe to his views about mentally disordered prisoners who do not pose a serious risk to the public and could more appropriately be treated in the mental health system.

My right hon. Friend the Secretary of State for Health has made clear to the House the importance that he attaches to introducing legislation. For reasons that the hon. Gentleman will fully understand, I cannot make any promises about when that will be. My right hon. Friend has already published the fact that he is investing an extra £700 million in mental health services over the next three years, not least to tackle the problem that the hon. Gentleman identified.

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