§ Debate resumed.
§ 4.2 p.m.
§ The Earl of MANSFIELD
My Lords, turning to the Motion before your Lordships' House, I am sure that your Lordships would wish to thank the noble Lord, Lord Allen of Abbeydale, for giving us this opportunity to debate the report of the Committee on Mentally Abnormal Offenders. The first remark one has to make is that it is indeed a formidable report which the noble Lord, Lord Butler, and his colleagues have produced for the consideration of the Government and indeed of the community. It embraces not only the classification and identification of mental disorders but also pre-trial, trial, and after trial treatment of offenders.
All these stages are discussed, and far-reaching proposals and recommendations are made. We are fortunate that the noble Lord, Lord Butler, is in the list of speakers. We shall listen with interest to what he has to tell us, not just about his report but perhaps about any change of opinion or emphasis which he may have reached as a result of events since the report was published. As the noble Lord, Lord Allen, has said, the 1821 subject is much too large to enable one to do more than discuss one or two aspects of the report. I am sure that one of the more disturbing aspects of the present situation is the treatment of persons who may not present any outward manifestation of mental disorder, and who may go through the criminal process without any disorder being perceived or recognised.
Putting the matter shortly, the Committee recommend that there should be a more efficient pre-trial screening system, partly by the use of social inquiry reports. It is said that such could point to signs of mental disorder and indicate the need for a full psychiatric report. I am hound to say from my own experience in the courts that it very often happened, either when one was prosecuting and read the police report or when one was defending and was confronted by one's instructions, and even by one's client, that the thought did cross one's mind that perhaps all might not be well mentally—and I do not mean merely by the defence which one was being urged to put forward in his favour. But there was nothing—and I am sure the position still obtains—that one could really do about it.
One has frequently been left with the uncomfortable thought that a person has been dealt with by a court who either should not have been dealt with in that way or, even worse, should never have been put before a court, so that a recommendation such as this has far-reaching importance. Having said that, one has to take the social worker and the social inquiry report which he produces as one finds them. In most cases they are already gravely overworked, and it is difficult enough for judges or magistrates to obtain a social inquiry report of any kind, let alone to be able to obtain one possibly on a suspicion of a police officer, or somebody, that there is mental trouble. I fear very much that, if this method of screening was adopted, it would require far greater financial resources and more expertise than are available at the moment. I expect to hear the noble Lord, Lord Harris of Greenwich, say when he comes to wind up this debate, as he will say about many of the recommendations in this report, that in times of financial stringency such as these there is little that can be done other than the identification of need and the establishment of priorities.
1822 I am glad that so far as the pre-trial stage is concerned the report recommends that what I might term Section 136 procedure should be used more frequently than it is at present. The object is, of course, to keep out of court offenders who inevitably will require psychiatric treatment. The report rightly points out that regard has to be had for the public interest, especially where the offence is serious. If I may point a minor finger of criticism at the report and its recommendations, I am not sure that the Committee had quite the regard for the public interest that one would like to see in such circumstances.
One can think of examples all too easily where too much regard might be had for the individual and not enough for the public interest. There are many cases which might come to mind by way of example. A fairly trivial one might be a case, for instance, of indecent assault. It might well be the case where, if the offender was not produced and dealt with by a court in whatever manner, public opinion might be unjustifiably yet understandably outraged by what it might consider to be a cover-up of the offender, even if that offender was mentally ill, by reason of the fact that he had not been dealt with in a court of law which is, or should be, empowered to make the right and proper decision as to his future.
I turn briefly to the trial stage. I am sure that many will welcome the replacement of the unfit to plead procedure by that of being, as it is called, under a disability. One of the difficulties has always been that an alleged offender may be put into a mental hospital without trial if he was found to be unfit to plead. And it is surely sensible to provide for a trial even if, at the end of it, the defendant is found under a disability. Equally satisfactory is the replacement or apparent replacement of the M'Naghten rules by the special new verdict of not guilty on the evidence of mental disorder.
As the noble Lord, Lord Allen of Abbeydale, said, the M'Naghten rules have in the past caused a great deal of difficulty, not least to practitioners, and their effects could well, so far as the individual is concerned, be capricious. If these recommendations are accepted, it will I think make it easier for a defendant who intends to rely on this defence to 1823 give the Crown the required notice which the Committee recommends, which I wholeheartedly endorse. Furthermore, he can give advance warning of the type of evidence that will be adduced to put forward his propositions—that is, evidence of a psychiatric nature—and, generally, the defendant will be able to put forward his case, if not in agreement, at least with a form of agreement with the Crown, so that something in the nature of an agreed case is put forward for the consideration of the judge.
I say this because, from my practice, I always remarked that the liaison, if that is the word, between the Crown and the defence was frequently non-existent and indeed on a number of occasions in my experience there was hostility, particularly if the prosecution thought that the defence had thought up an ingenious scheme to enable the defendant to escape what might otherwise be a long prison sentence. This suspicious attitude on the part of the Crown might well be compounded, and frequently was, when the expert giving evidence, however distinguished, was well known for his or her aversion to bringing mentally unsound offenders to a criminal court at all, and was even less willing that they should have to undergo the burden of a conviction. Any proposition that is put forward to reduce the strain on the defendant and at the same time convince the court of his state of mind with the least possible trouble should, in my view, be pursued.
I come finally to the position of the mentally ill once they have been disposed of by the courts, and I do not have to dwell on the fact that, generally speaking, our prisons are grossly overcrowded and that the position is not getting any better. What is alarming is the number of the mentally ill who are in prisons, and I therefore ask the noble Lord, Lord Harris of Greenwich, what are the present figures and what is the trend? One would like to know whether the situation is getting better or worse or whether it is static. Last autumn, a figure appeared in the Press of 900 prison inmates who would be better off in psychiatric hospitals rather than behind bars. I should emphasise that the figure of 900 is the figure at any one time; it was made up, supposedly, of 400 persons 1824 mentally ill, 200 subnormal and 300 psychopaths—that is to say, grossly irresponsible or abnormally agressive persons.
Even graver is the thought that some mentally disordered offenders are denied psychiatric treatment because, by reason of their disruptive records, they are denied admission to National Health Service psychiatric hospitals. One understands and sympathises with the difficulties of the staff and the objections they have to such persons being admitted to their hospitals. Nevertheless, it is disturbing that the figure should be so high. One realises that planning permission poses problems for health authorities when trying to establish new places. Would the position be ameliorated in the Government's view by the setting up of regional secure units as recommended in the report, with all that that of course entails? If such units were set up, a number of those at present in open conditions could be transferred, which would increase the protection given to the public, and if the level of mentally disturbed patients in prisons were reduced, I suggest that that would lessen the strain on the prison service.
However, there are some formidable and some less formidable objections to these centres, some of which Lord Allen touched on. The regional secure units themselves would need the appropriate nursing staff, who would have to be attracted by favourable conditions of work and pay and would probably want a fairly substantial differential as between secure units and the ordinary hospital. All in all, I suggest that these units will need massive amounts of finance and I imagine the noble Lord would agree that they are for the future, if at all, and that what the Government must deal with now is the present overcrowding and neglect. Is it the Government's intention—I echo the question addressed by Lord Allen—to set up the national advisory body recommended in the report to keep the situation under review,to report where problems are arising and to assist towards solutions".In the end, I believe interim measures will have to be provided while longer-term solutions are planned and financed. In the meantime, the community is greatly indebted to the noble Lord, Lord Butler, 1825 and his Committee for their thorough review of what must be a disturbing social picture and for practical suggestions and recommendations as to how the community should go about solving these many and difficult problems.
§ 4.17 p.m.
My Lords, noble Lords will be deeply grateful to the noble Lord, Lord Allen of Abbeydale, for his initiative in giving us an opportunity to debate this really vital topic. Not only does it allow noble Lords who are experts in this field, with vast experience and expertise, to place their views on the record and give us the benefit of hearing them; it may also, as time will perhaps show, extract some information from the Government about their intentions.
We know, and have already been told, that we are shortly to expect a White Paper with green edges regarding amendments to the Mental Health Act 1959. I have not noticed that either the noble Lord, Lord Wells-Pestell, or the noble Lord, Lord Harris of Greenwich, are clutching White Papers with green edges or indeed with edges of any other hue, but I hope they may have at hand all the information that will be contained in the White Paper and that perhaps before the day is over they may let us into the secret. That makes me wonder whether it would have been more helpful if we could have changed our procedures to enable us to hear the Ministers before we speak; that could perhaps have made this occasion doubly valuable, because we could then have commented on what is actually going to happen rather than on what we hope will happen.
I should begin by saying clearly that in my view no amount of administrative manoeuvring within the constraints of the present inadequacies of resources in this whole field can make any real and satisfactory difference to the plight of those we have in mind—and by that I mean the patients and those responsible for them. Whatever we do will make no difference unless radical and urgent action is taken with regard to essentials—matters like premises, facilities, staff, equipment and resources generally in this whole sphere. If anyone entertains doubts that there are inadequacies with regard to hospitals and other premises, I should 1826 perhaps remind them that, in this connection, the EEC Commission on Human Rights is at present investigating the overcrowding and inadequacy at Broad-moor, and there are other institutions which are perhaps no better.
There are also in various parts of the country serious inadequacies regarding staff. My use of the word "inadequacies" is no reflection at all on the staff in those places; they work under very grave difficulties. Here, I should like to make a further point, but I do so with some caution because I am anxious not to be misunderstood. I have on many occasions spoken in your Lordships' House on behalf of overseas doctors, who have made an immense contribution to our National Health Service. But it really is difficult in certain areas of the country if almost all the psychiatrists happen to be foreign doctors with certain language difficulties. Here the difficulty in psychiatric treatment is not the difficulty of the patient understanding the doctor; it is the very real fear which the patient sometimes has about whether the doctor can really understand him. I shall not go any further on that matter, save to say that there are grave deficiencies in our resources, and whatever we do in altering statutes and amending the Mental Health Act 1959, or making various other administrative changes will not really put matters right unless we attend—and attend rapidly—to the basic essentials.
I now move on to the Report of the Committee on Mentally Abnormal Offenders, by the noble Lord, Lord Butler of Saffron Walden, and his colleagues, which we are here to discuss. The Motion of the noble Lord, Lord Allen of Abbeydale, refers to the implementation of the outstanding recommendations made in the report, which would appear to imply that very large chunks of the Butler Report have in fact already been implemented. I regret to say that that does not seem, at least to me, to be the case. For my own personal knowledge I can itemise only two matters on which any real progress seems to have been made. First, some progress has been made in the establishment of regional secure units. But so far as I know—I am open to correction—there are only two so far, and they are of an interim rather than final nature. One of them is on Merseyside, the other in Surrey.
1827 Secondly, it seems to me that a little progress has perhaps been made with the establishment of the Advisory Board on Restricted Patients, which arose from a recommendation contained in the Aarvold Report. But I should add that the proceedings of that board are secret. In addition, it may be thought by some that its activities duplicate the functions of certain other bodies.
Having said that, I should not like it to be thought that this enlightened, comprehensive, and immensely valuable report which the noble Lord, Lord Butler, and his colleagues have produced has had no other effect; of course it has. There is no doubt at all that it has brought about changes in the climate of thought in this whole field, which I hope will themselves prove to have had some impact on the Government's plans, of which we hope to hear more later in the debate.
Obviously, we shall have to debate real proposals in due course; so I believe it would not be helpful if here and now I went into further details on these matters. But, before sitting down, I should like, briefly, to go through one or two matters partly arising from the Butler Report and partly emerging from this field as a whole, and related to the Butler Report, which I very much hope will be enshrined in the forthcoming legislation when it appears.
First, undoubtedly, we must look very carefully at all the procedures in relation to the mental health review tribunals. As I believe Mind—the National Association for Mental Health—has made clear over and over again, there are serious deficiencies in the way in which these mental health review tribunals work. The noble Lord, Lord Butler, and his colleagues have drawn attention to some of these deficiencies, and attention has also been drawn to them by other people in other places. I hope that the whole working of these tribunals would be looked at again. I hope that there will also be considered the securing of easy access to these tribunals by persons who are detained, whether under Section 25, 26, 29, 136 and, of course, the vital Sections 60 and 65 of the Mental Health Act. One should like to feel that all these people had easy and regular access to the tribunal. I should also like to see certain of the procedures of the tribunals changed. Much is said 1828 about this by the noble Lord, Lord Butler, and has been said by others, too. In particular, I should like to see efforts made to ensure that, when the tribunals sit, the persons dependent upon them hear a very early decision, accompanied by the reasons which have brought about the decision.
In this connection, I should like to add a point which is certainly not contained in the Butler Report. In so far as the decision is a recommendation of the Home Secretary, and since his recommendation is made on the basis of the mental health review tribunal's actual proceedings, one wonders whether something could be done to make the Home Secretary's decision in these situations accountable, or more accountable, in some way.
Secondly, I should also like to see in the coming legislation progress towards a radical review of all the procedures whereby patients are compulsorily admitted to, or detained in, hospitals. I do not want to go into details here. Noble Lords who have already spoken have pointed to odd aspects of this matter, but the various sections of the Mental Health Act 1959 are highly complex. Very often there are patients detained in hospital who, frankly, have no idea whether they are detained under any particular section at all, or if they are, which section it is and precisely what it means. Sometimes a patient is not able to understand these matters, but frequently I have had to deal with relatives who ask questions about this and it has been very difficult to get them the answers.
I now move to my third point which I should like to see enshrined in the coming legislation with regard to the M'Naghten rules. Many years ago in another place I endeavoured to introduce a Private Member's Bill to do away with these rules, or to change them, but like most Private Members' Bills, it met the fate of running out of time. But I recollect that I was supported at that time by many distinguished lawyers who were cosponsors—Mr. Mark Carlisle, Mr. Emlyn Hooson, and Mr. Sam Silkin, as he then was—and, when I remember who Mr. Sam Silkin now is, my hopes rise as to what may follow from the review which is being carried out.
1829 The noble Lord, Lord Allen of Abbey-dale, pointed to many of the disadvantages of the M'Naghten rules, as did the noble Earl, Lord Mansfield. I have never had any doubts about this, and looking back into the record it is interesting to note that in 1874—although I know things have changed since then—Lord Bramwell, giving evidence to the Select Committee on the Homicide Law Amendment Bill in June, 1874 said,the present law lays down such a definition of madness that nobody is hardly ever really mad enough to be within it".We have made vast improvements and great changes, and it is true that we had an improvement in that direction in the Homicide Act of 1957, which brought in the new principle of diminished responsibility. In that regard, I was inclined to agree with an eminent authority, Dr. Howard Jones, who, in his excellent book Crime and the Penal System, said:Many will feel that the procedure by which insane persons can be sentenced to prison for manslaughter is hardly a satisfactory final solution".The noble Lord, Lord Allen of Abbey-dale, quoted a case, and I should like to refer to another. It was a case of a young man of 17 years of age, who was convicted of murder. At the time, many people thought that he was suffering from schizophrenia, as I think he probably was. However, he did not plead insanity, quite understandably. There was no prospect of his being executed in view of his age, and presumably he preferred prison to Broadmoor. He went to prison, and within two years he had murdered another prisoner. It was a case in which our second line of defence—and I know we have a second line of defence; that of the various methods of examination of prisoners prior to and following sentence—had in fact broken down. That is no criticism of the people involved, but I think it points to serious defects in the rules as they then were.
Some years ago I made a point, which with leave I should like to repeat now, with regard to the horrible case of Christie, the multiple murderer. There is no question at all that Christie was M'Naghten sane, as one might say; and Christie was in fact executed. But if Christie's peculiarities and mental abnormalities had resulted, not in the death of his victims but in those victims being 1830 maimed, he would undoubtedly not have produced a plea of insanity and the prosecution would not have had the right to introduce that plea. He would then have had to be sentenced to prison for a violent offence, and, necessarily on the basis of our law as it then was, the sentence would have had to be a finite sentence, which would have come to an end with his release. Now I know that there is a longstop and that there are other methods of examination, and so on, which are very important; but I think that this example and others which have been quoted perhaps point to some of the difficulties which have arisen over very many years from the general concept of the M'Naghten rules.
I have made those particular points because I am not inclined wholly to agree with the report of the noble Lord, Lord Butler of Saffron Walden, which I think reiterates that the onus of introducing the question of the mental state of the accused person should be laid clearly and definitely on the defence. It would seem to me that, where the mental condition of the alleged offender is in issue, either side ought to have the right, and indeed the duty, to introduce that, with, of course, proper safeguards.
Let me move on very briefly to my fourth point. I hope we shall also be looking, not only at the rights of people who are being taken to hospital compulsorily but at the rights of patients when they are detained in hospital. By those rights, I am referring to matters such as the right to receive and write letters and the right to receive visitors; and perhaps in certain cases we might even think again about the right to vote, which is taken arbitrarily and totally from persons who are detained in hospital in that way. Finally, I think we shall have to deal, and deal carefully, with the very delicate and very difficult matter of compulsory treatment. I do not want to go into any detail about this now, but I know that it is in many people's minds, and it will have to be thought about. I know that the intention when a person is detained for treatment is that he should receive treatment, but I myself feel a little uneasy about any kind of movement towards a situation in which individuals, whatever their mental state, are compelled to receive treatment when clearly their wish is not to receive it.
1831 My Lords, I think that is enough from me. I hope that later in this debate we shall hear things in which I shall be very interested, from the noble Lord, Lord Wells-Pestell, and from the noble Lord, Lord Harris; and I shall now wait to hear the contributions of other noble Lords, to which I shall listen with great interest. Finally, let me thank the noble Lord, Lord Allen of Abbeydale, once again for his initiative in giving us this opportunity to have a look at a really urgent matter. Perhaps I should also thank the noble Earl, Lord Mansfield, for, in a delicate way, pointing to a strain of caution, which is necessary in this field and which perhaps shows the extent of the difficulties with which we are faced, and the kind of conflicts which inevitably arise when one has to consider the well-being of a human being as an individual and the safety of the public among whom he lives and to whom, we hope, he will be able some day to return.
§ 4.34 p.m.
§ The Earl of LONGFORD
My Lords, the noble Lord who has just spoken has paid generous tribute to various speakers, and I join him in those tributes and add his name to theirs. It is an unqualified privilege to speak after the noble Lord, Lord Allen, whose services over such a wide area are unsurpassed in our time. It is a privilege, qualified by a certain trepidation, to speak just before the noble Lord, Lord Butler. The last time I spoke in his presence, in St. Margaret's, Westminster, he came up to me afterwards, paid me some guarded compliment and then said, "It is a pity they do not put microphones in here". I looked at him askance, and he said, "Of course, I could hear perfectly but I was sitting in the front row." That, I think, is what is called a Butlerism; I think he has become famous for that kind of compliment. At any rate, I speak in front of him; and another reason for trepidation is that I am going to be critical, to say the least, about one aspect of his proposals—the regional secure units—not from the theoretical point of view but from the point of view of practical implementation. But I hasten to say that, of course, his whole report goes far wider than that and deals with many matters of profound significance in a most impressive style.
1832 Coming to these regional secure units, I have given some notice of my line of thought to the noble Lord, Lord Wells-Pestell, and I suppose, to put it in its simplest way, that I am going to ask him to tell us whether this idea of the regional secure units has been quietly dropped overboard. Perhaps you do not drop a thing quietly overboard and announce that you are quietly dropping it overboard: one process would defeat the other. At any rate, will the noble Lord say whether the Government are going on seriously at all with these regional secure units? That is the main point that I want to place before him.
Now, like other noble Lords, in trying to prepare myself for this debate I have made one or two inquiries on the spot. I visited Broadmoor, for example, not by any means for the first time. There I found Dr. McGrath, the formidable superintendent who has served the State so well in that capacity for over 20 years, a strong supporter of the Butler proposals for regional secure units. He told me that they would greatly reduce the pressure on Broadmoor, and would act both as a filter and a buffer. They would siphon off a number of disturbed patients who are now sent to Broadmoor because they are too difficult for the ordinary mental hospitals to handle; and, at the other end, they would take over many patients who are ready to leave Broadmoor but whom the mental hospitals are at present too nervous to accept.
What shocks Dr. McGrath—and I really do not think he would mind my quoting him, though of course he is a serving superintendent—is the failure of the regional health authorities to push on with the construction of these secure units. He gave me a table, which I think has been published, which shows how, disgracefully enough, the funds allocated by the Ministry for this precise purpose have either not been used at all or have been used in other ways. If we accept the point, for the sake of argument, that these secure units are highly desirable then somebody has to be blamed for their nonappearance; and from that point of view perhaps the noble Lord will explain what has gone wrong. Various explanations were offered while I was at Broadmoor, and have been since. There was the usual accusation of bureaucracy, and I am quite ready to join in that sort of accusation, at 1833 any rate while I am not likely to be in any responsible position. Then, of course, the difficulties with the local communities and the hospital staff were also mentioned.
What I had not anticipated—the noble Lord who spoke last would know all about this, but some noble Lords would not—was the blame bestowed by the forensic psychiatrists on their non-forensic brethren, who are, of course, the great majority of psychiatrists. I do not know whether all noble Lords here can tell a forensic psychiatrist from a non-forensic psychiatrist at sight, but at any rate that distinction was made. I know, of course, that the noble Lord, Lord Stone, would; but, then, he understands everything in the medical world, including the nature of my own mental and physical difficulties.
§ The Earl of LONGFORD
At any rate, my Lords, we were told that the enthusiasm of the non-forensic psychiatrists for these units is very tepid, and yet no one—certainly no one at Broadmoor—doubted that the great liberalisation in the mental hospitals, which we all welcome, had left a whole category of dangerous men for whom security remains necessary. At present, apart from the special hospitals such as Broadmoor, there is nowhere to send them except prison, and yet everyone at Broadmoor, and I think most people, including noble Lords and Ministers, would agree that sick people, in Dr. McGrath's words, should not be imprisoned. We are talking about sick people. On the face of it, therefore, after a visit to Broadmoor, one would if that was the full extent of one's inquiries, emerge with the view that one should go full steam ahead with secure regional units and denounce everybody who drags his feet or stands in the way.
After that, I visited Knowle Hospital Special Unit but, after coming back from Knowle Hospital Special Unit, I am afraid that I found myself more rather than less confused. I had been at pains to find, with the help of the Ministry, a secure regional unit on the lines suggested by the Butler Report. The Ministry had done their best for us. I gather that Knowle had more to offer than anywhere else. I am not sure that the noble Lord, Lord Winstanley, is familiar with what is 1834 going on at Knowle. He mentioned one other unit but I am not sure that he mentioned Knowle. Certainly, the Wessex Region seems to have spent more than any other region of the funds which were earmarked by the Ministry for the purpose.
I was shown the Knowle Special Unit with 14 beds and I was much impressed with the way that things were being done; but it was a far cry from this little unit to the kind of unit which is recommended by Lord Butler. The first thing that struck me about Knowle—which was the special unit that I was assisted by the Ministry to visit—was that the door of the unit was not locked. It soon transpired that in no physical sense was the unit more secure than the average ward in a hospital. I was told, however, that the unit was secure in a different sense, not in a physical sense but another sense, because of the high ratio of staff. There were, in fact, 13 nurses to 14 patients. This ratio was apparently much higher than in a mental hospital or a general hospital, or in Broadmoor.
In a document handed to me by the Knowle psychiatrist, it was revealed that more than two-thirds of the patients were voluntary. Therefore, the unit cannot be said to be dealing primarily with the problem of delinquents, the problem we are discussing today. It was dealing mostly with voluntary patients. So, taking this hospital, which was recommended to me as a good field of study, it was difficult, if not impossible, to recognise this as the kind of secure unit which was envisaged in the Butler Report. So, to the best of my belief, there is no such unit in the country at the present time.
I should add—and it is perhaps of rather more long-term importance—that those whom I spoke to at the hospital, including the excellent shop stewards, were highly critical of the Butler proposals in this matter. I am sorry to say this in front of the noble Lord, Lord, Butler but that is perhaps more chivalrous than to say it behind his back. In any case, he follows me on the list of speakers and can therefore put it right.
§ Lord BUTLER of SAFFRON WALDEN
My Lords, if the noble Earl is basing his observations on what he saw there, it was nothing to do with my report and I can accept no responsibility.
§ Lord BUTLER of SAFFRON WALDEN
My Lords, I am very interested in the noble Earl's argument and I hope that he will continue.
§ The Earl of LONGFORD
My Lords, I was going to do so whether or not the noble Lord hoped that I would. The shop stewards, I am afraid, said flatly that they were utterly against the Butler approach. In that sense, whether they were right or the noble Lord was right, I am only telling him that the shop stewards were very critical of the approach. They were enthusiastic about the liberalisation. In saying that, I am not saying that these gentlemen are infallible but only what these gentlemen recommended to me by the Ministry actually told me. They were very enthusiastic about the liberalisation which has come to mental hospitals since the Mental Health Act. They said that to introduce the old restrictionism in any new unit established on the lines, they thought, of the Butler proposals would be putting the clock back and should not be tolerated for a moment. That is what the Government must cope with on the ground if they try to apply these criteria. Even if there were no such thing as bureaucratic inertia, the Government have a difficult problem in that situation. It was brought home to me that this new unit, like others being set up elsewhere, was an interim measure. Lord Butler had envisaged larger units. The psychiatrist in charge was ready for something somewhat larger than at present but nothing on the scale of Butler.
Since that time, I have come to feel that the failure to produce the so-called "Butler units"—and I am sorry if the word is inappropriate; but I am sure that the noble Lord will not mind my using it—may be due to something deeper than bureaucratic inertia. I am sure that bureaucratic inertia plays its part and, given half a chance, operates all too strongly. This is what I am putting to the Minister—and I went to see only one place but I gather that there is nothing sensibly better to be seen—can it truly be said that a real agreement on the desirable kind of unit as envisaged by Lord Butler has yet been reached, quite apart 1836 from the construction of the unit; or is it on the point of being reached among the various parties concerned?
In some bewilderment at this stage, I consulted MIND, which some of us think of in connection with the National Association for Mental Health who have done such fine work over the whole field of mental disorder and of which the noble Lord, Lord Butler, is the honoured President. I will not begin to summarise the considered opinion of MIND regarding abnormal offenders in general. They had many laudatory things to say about the Butler Report. They say, for example:It suggested rather impressive reforms in terms of prevention, rehabilitation and after-care improvements in the conditions for, and treatment of, the range of people who are called abnormal offenders'.I am sure that all that is very very true. But in regard to the regional units, they are much more reserved. I am quoting from MIND who, I believe, are described as the campaigning aspect of the National Association for Mental Health. They say that the evidence which comes from the Clancy Committee set up by the DHSS demonstrates that the regional secure units are not in the least likely to draw many people who would otherwise be going to the special hospitals. They say:If the regional secure units immediately become cluttered up with people from ordinary psychiatric hospitals they are obviously going to be of very little help to special hospital patients and to prisoners.If MIND are right, then the dream of the good people of Broadmoor that these regional secure units are going to make life easier for them is a fantasy. The real problem, as MIND sees it, is that local hospitals at the present time—and I think this is drawing towards what was said by the noble Lord, Lord Winstanley—are given very little help in coping with difficult patients. So MIND would firmly recommend that the resources should be concentrated as far as possible on the assistance of the local psychiatric hospitals—and may I add what I am sure would be their view—and on providing much more adequate resources for the special hospitals and for psychiatric facilities in prisons.
I found total scepticism when I was at the Knowle hospital about the after-care 1837 which is provided at present for mental patients. Certainly my experience of after-care provided at special hospitals or in prisons leads me to the same conclusion. If there are resources available, I hope that a high proportion will be devoted to after-care.
That does not mean that MIND feel that all progress with the special secure units should be stopped; they think that there should be experiments made in that field. But, certainly, their general point of view (which I share) is that there are other claims which are more insistent. We are all aware that in matters of this kind there can be no absolute certainty and no abstract standards of perfection.
Differences of opinion on exactly how to treat an abnormal patient will not be resolved in the near future. Indeed, they never will be. I am all for experiment of different kinds; but it would be unforgivable to use these differences of opinion, which are certainly going to persist, as an excuse for further procrastination in the development of our treatment of abnormal offenders. These abnormal offenders are always going to present a very perplexing problem, particularly in young ones, so it is not dogmatism on my part or on the part of any noble Lord here. Let us conduct these experiments; let us continue the arguments; but, above all, let us push on much faster in providing the resources that are so badly needed for dealing with abnormal offenders.
§ 4.51 p.m.
§ Lord BUTLER of SAFFRON WALDEN
My Lords, I join with other noble Lords in thanking my noble friend Lord Allen of Abbeydale for the kind tribute that he paid to our report. Listening to the speech of my noble friend Lord Longford one would think that it was my report alone. As a matter of fact, two particularly learned justices were on the Committee; namely, judges, as was the best and most well-known psychiatrist or doctor in Britain, Sir Denis Hill. At any rate, he is head of the Maudsley Hospital and did a distinguished job. It consisted of psychiatrists from the North of England and from the South. It consisted of many other magistrates, and it consisted of people who 1838 joined with us in a unanimous report. Therefore, I am greatly interested in the noble Lord's arguments and I must take them as representing my colleagues' as well as my own.
I was very interested in my noble friend Lord Mansfield's speech with which I largely agree. It is clear he has special knowledge from the Bench which has helped him in giving his arguments. I hope that noble Lords from the Liberal Benches will be answered by the Government, because some of the points were not in our report. They deserve attention, but the question is whether they can all be reached today. In the case of the speech of my noble friend Lord Allen of Abbeydale, he covered most of the subject so I shall not attempt to do that myself. I should like to stress the importance of our formula in relation to the M'Naghten rules. The M'Naghten rules are very old now—they date back to 1843.
I may as well refer to that now. When I went to see Mr. Maudling as Home Secretary, he referred to the case of Graham Young, a dangerous lunatic, to which my noble friend referred. I think he thought he would appoint a nice little Committee under me to get him out of political trouble about Graham Young and that would be the end of the subject. I was perhaps foolishly sitting on a particularly comfortable sofa, which I have never sat on since, nor have I ever been in the Secretary of State's room at the Home Office, or in any Minister's room in either office, Social Security or Home Office, since.
I was astonished when I received the real remit of what we had to look at. It was very much broader. It contained not only a reference to the criminal law as we know it, and the question of whether the word "insanity" is or is not out of date, whether we should base defence on mens rea, which would take me some two hours to explain, except to the noble and learned Lord, the ex-Lord Chancellor, sitting opposite. It entailed a great deal of not exactly criticism but desire for revision of the famous Mental Health Act. I, as a Conservative, helped to frame that Act and I often spoke about it both in the House and over the country. It is a magnificent Act but I think needing revision. Those were what we were faced with. I will take the M'Naghten rules 1839 first. I promise to come to these wonderful units; and also I promise to come to other subjects in a minute or two. The formula that we adopted in dealing with the M'Naghten rules is in paragraph 18.18 on page 222 of the report. It says that insanity being out of dateWe propose that the new formula for the special verdict should be not guilty on evidence of mental disorder'.This is based on certain elements which are referred to in the previous paragraph, and the whole problem of mens rea and such technicalities, is referred to in paragraph 18.20 onwards. For noble Lords who are interested, I recommend them to look at those parts of the report.
What is important is that before we came to this decision on altering the M'Naghten rules and changing the criminal law for the first time for over 150 years, we consulted the Law Lords. We consulted the Lords Justices of Appeal and, in particular, we consulted Lord Justice Ormrod, whom I saw again before this debate to see whether he still agreed with our decision. In each case the Law Lords, starting with hesitation, came round to our point of view. In one of these paragraphs that I have quoted there is a statement by Lord Denning. I am afraid that, like some of the statements of geniuses, we did not quite agree with it; but the fact is that the noble Lord, Lord Denning, is himself an expert on mental disorder and we also consulted him. So much for the M'Naghten rules.
I also want to refer to certain medical definitions which were given by Sir Denis Hill and which are very important. Those are on page 229 of the report. It says in paragraph 18.35:A mental illness is severe when it has one or more of the following characteristics …".Then the characteristics are set out and noble Lords can follow, if they so desire, the details lying behind our decision on the M'Naghten rules and our decision on the definition of mental illness. Those are in the report, and it is a clear one.
I have been told that the paragraphs of the report are some of the clearest ever written. I do not know whether to believe that. I should like to express my thanks to the secretariat, Mr. A. W. Glanville, and Miss M. Purvis. We dispensed with all shorthand and so we were 1840 probably one of the cheapest Royal Commissions ever reporting. The only expense was incurred because, for some reason—which I did not understand—the Home Office had to hire some premises. We had some pork pies and a few rolls of bread for lunch; otherwise I do not think we imposed a great deal of expense on the public. We raised in the end, I am afraid, a great many recommendations.
What I should like to do before I go into some of them is to say this to the noble Lord the Minister. Since the Education Act of 1944 I have managed to keep close contact and to be allowed to criticise and talk with every Minister of Education right up-to-date. I have even been asked to lunch by Shirley Williams. I have discussed what I hope will be reforms in certain directions. I shall probably be in agreement with them, and when they come forward I will be speaking here about them. I have also been in touch very closely on Treasury matters with the Chancellor of the Exchequer, whom I invited to one of my final dinners at Trinity College. He expressed great joy that on that very day he had exceeded my length of term of office of over four years by one day. I hope that he will be successful because it is essential to destroy and kill inflation.
I must say to the noble Lords, Lord Harris of Greenwich, and Lord Wells-Pestell, that although I have met them of course before in other incarnations, I should like to meet them and their Ministers and see a little more, for example, of the work of the Minister of Social Security. I can always get my way into the Home Office by devious means, having been there for five whole years running, and I am provided with a lot of useful information. I know roughly what is going on there. But I do not even know where the back door is at the Elephant and Castle. So it is very difficult to keep proper contact. I hope that some arrangement might be made by which we might have a consultation, and into that consultation, which would be perfectly simple, could be included, for example, some of the doubts of the noble Lord.
The real truth of the final terms of reference we were given was that there was a growing realisation of the need to reappraise the operation of Part V of the Mental Health Act 1959—that is the powers and facilities available for dealing with 1841 mentally disordered offenders, and power to protect the public at the same time. That matter has been referred to by three noble Lords who have spoken. It was a most daunting task and, while we took three years, I must say to the Government that they have taken practically three years—there are still a few months to run—before giving us any satisfaction whatever.
I think it is now time that the country woke up to the fact that certain things and certain news may be very exciting, but that certain politics and certain difficulties may be very embarrassing for the Government. But my noble friend who opened the debate and I, and those who are speaking, are dealing with the most abject and lowest portion of the population who are, in my opinion, being badly neglected by us all. Therefore, the fact that my noble friend has brought forward this debate is vital to the country as a whole. To be mentally afflicted is bad enough, but if you read the report of the Royal Commission on Hanging and see the brilliant language used there by the then secretary, Mr. Graham Harrison—probably the most brilliant man in the Home Office—you will see that there are many people who also have mental disorder. I shall have to disagree later with my noble friend Lord Longford on the subject of how to deal with certain people called psychopaths.
There are some topics to which he attached particular weight. The problem of the psychopath is one that appeared out of the operation of Part V of the 1959 Act. It is certainly one of the most intractable and perplexing questions one could deal with. The problem was: how should we deal with the psychopath? First, we have to try to find who he is. If we were to ask Dr. Johnson, we might get an answer, but I cannot think of anyone living who could give an answer. Dr. Johnson, when asked "What is poetry?" said,Well, sir, tis much easier to say what it is not. We all know what light is but it is not easy to tell what it is.It is not easy to tell what a psychopathic disorder is and, as the Ministers who represent that Department know, their officials feel very great doubt about the position of the psychopath. It is certainly a great problem.
1842 I claim that the existence of psychopathic disorder is inferred from serious irresponsible or abnormal aggressive conduct. I daresay that when my noble friend Lord Longford was being led round by Dr. McGrath, he may have been warned, for example: "That gentleman over there might suddenly hit you because he is aggressive and dangerous: he is in fact a psychopath." Dr. McGrath and his friends are so clever that, on the whole, they manage to look after most of them; but these are singularly dangerous and unpleasant people.
This uncertainty of identification is often difficult to discern, and is paralleled by continuing uncertainty as to the proper way to deal with it. Some measure of success is claimed for certain methods of behaviour modification in some local hospitals, and no doubt we should like to try that. The Committee formed the view that a dangerous psychopath of the more aggressive type has no place in local psychiatric hospitals and that, while the option of a hospital order should not be discarded for psychopathic offenders in general, the modification of their behaviour as the object of treatment is more likely to be attained within the penal system than within hospital. That is where I am now approaching my noble friend's doubts and worries.
With these considerations in mind and, with a view to establishing more clearly the responsibilities of the Prison Service, the Committee put forward two main proposals. One was that the courts should no longer be free to make a hospital order in respect of a psychopath, unless the court is satisfied that a previous mental or organic illness or an identifiable psychological or physical defect relevant to the disorder is known or suspected. That was the first, and in addition there is to be an expectation of therapeutic benefit from hospital admission. In that way, we had one suggestion for psychopaths. The second suggestion concerned the difficulty of dealing with a dangerous and anti-social psychopath. It was suggested that a start should be made with a pilot study, which might be carried out in an existing part of a prison. The noble Earl, Lord Longford, observed that we were not so positive as to suggest that a pilot scheme should not be tried. I hope that the noble Lord who is to respond to 1843 the Motion on behalf of the Government will be able to say something on this extraordinarily complex issue.
Of course we did recommend in an interim report that a security unit should be set up. The House must realise that the Government accepted our interim report. Secondly, it must be realised that the Government accepted that they would go forward with this idea; and so we are asking today that something should be done. We were told at the time of our report by Ministers that there was no money.
Today there is an enormous blaze of headlines in the newspapers about the oil resources. These are to be used mostly for energy and for the re-creation of industry. At the very bottom the words appear in small print, "social services". I want the Ministers today to get some of that money. Social services are included in the White Paper on oil, and if they are included, something ought to be done for the mentally disordered, and particularly for the psychopath. Not only that, but as I came to sit in the House I had a paper, referred to by the noble Lord, published by MIND—the National Association for Mental Health, as I always call it—of which I am president, reminding me of the terrible conditions in Broadmoor, Rampton, Moss Side and the new Park Lane, a new special hospital which is far from completion. I was reminded of how it is becoming absolutely essential that public money should at last be spent.
If you visit Broadmoor and go to the left-hand side of the building, conditions are tolerable. On the right-hand side of the building, as you are warned by Dr. McGrath, the situation concerning bed room, sanitation and health is probably the most intolerable in the world. It is terrible that this should be going on and on. Here I am speaking six years after all this was put to me, as chairman of the Committee which produced the report. It is many years since I was a Minister—and I have been a Minister longer than anybody living in this country, in one Department or another. I must honestly say to the Government that these conditions are intolerable and I must ask that some of the oil revenues which are being blazoned today should be seized by their Departments and used for the relief which we want.
1844 The next problem that arose in this debate was the one about the liberty of the individual. That is a particularly important point. I have here a booklet about this, also published by MIND, which I saw only this afternoon for some reason. If people can afford £2.75, they can buy it; I am not allowed to make it a Government document! It is written by the Association's own lawyers and shows the importance of preserving the liberty of the individual and also the safety of the public.
Our first proposals were all very nice and were really in favour of the liberty of the subject, so far as was possible. But then a certain gentleman called Iliffe got out; he murdered his wife, cut her up and put her into the refrigerator. So we thought that that was a bit too much to allow, without a little control. Then, unfortunately, just before we were going to report—as the Minister will know—one or two other escapes occurred. In my opinion, the Cambridge rapist, who held the town to ransom for several months, could have been caught earlier. It was a girl in my office, who remembered a case of sex trouble, who reported it and helped towards the final arrest. This is all very well, but if you are going to have freedom of the subject you must also have security.
Sir Carl Aarvold was first appointed to a committee to look after this aspect, but we found, following on the view of the Royal Commission relating to mental illness, the Percy Commission and other such commissions, that that statement about the appointment of Sir Carl Aarvold was not enough and that it must be further strengthened. We therefore suggested the addition of an advisory committee, and that further permission should be sought—and the permission of the Home Secretary—before release could be made possible. I believe that this new compromise, which is much aided by the wisdom of Sir Carl Aarvold, will lead to fewer dangerous cases getting out and disturbing the public; and it is important that there should be this compromise achieved between the liberty of the individual, and the safety of the public.
As I said, I could go over many other paragraphs of the report. I believe that we should think a little more than we have 1845 done in our debate, so far, about aftercare. At the present moment, a man can be let out and the after-care may be so limited that he cannot do anything more. So he goes back and is, again, in the desperate situation which my committee and I saw in those sad, gloomy hospitals, so nobly and splendidly run by their superintendents. I think, also, that the problem of the inadequate, the rootless and, so often, homeless schizophrenic should be dealt with. One could go on with one person after another, but I feel that I have said enough to show that it is the honourable duty of your Lordships' House, as individuals and corporately, and it is the duty of the other House, to see that the Government of the day give us a little of these extra riches, which are coming to us, to help put right some scandals which are too great for this country to bear.
§ 5.13 p.m.
My Lords, the noble Earl, Lord Longford, spoke of his experience of speaking before the noble Lord, Lord Butler of Saffron Walden. I have to say that it is my fate or experience—and I hope that the noble Lord, Lord Butler, will take it as a compliment—to speak after he has spoken. The last occasion when I did so was in a debate on education, and here I am speaking with equally little knowledge on the subject of the report produced by the Committee of which he was chairman. I profess to know very little about this subject, but I am, nevertheless, very grateful to my noble friend Lord Allen of Abbeydale for inviting me to take part in the debate on the Motion in his name. I think that he was persuaded to do so by Dr. McGrath, the superintendent at Broadmoor—on what grounds I am not sure. It is, of course, very unwise in your Lordships' House, as everybody knows, to speak on subjects about which one knows little. Nevertheless, I am glad to take the opportunity, if only to make a single point on behalf of the probation and after-care service.
It is not without significance that the National Association of Probation Officers, of which I am privileged to be President, supported every one of the 138—or 140, according to my noble friend Lord Allen—recommendations in the report of the noble Lord, Lord Butler. NAPO is a body 1846 which is historically, and I think rightly, known for being critical of reports to Governments, whether they are by committees or commissions, on matters in the penal and social welfare fields, and here is a national association which has come out in total support of every one of Lord Butler's recommendations.
I am not here to plug the virtues of the National Association of Probation Officers, but I should like, in support of what I have said to point out that the Association does not run a union shop, and yet it is highly representative of the whole body of probation officers. It includes more than 4,000 of the total of 5,500 probation officers in the country. It consulted very widely before giving its evidence to Lord Butler's Committee, and it came out with this unanimous, strongly held and very positive view. The Probation Service is not, of course, involved with mentally abnormal offenders to the extent that it is with other offenders. But in giving its evidence, it voiced its particularly strong support for recommendation 1 in Lord Butler's interim report, and the supporting recommendation 2, bearing on the need—and the urgent need—for these regional secure units, of which we have heard so much this afternoon.
The National Association reinforced its support more recently—in fact, on 30th January this year—in giving oral evidence to the House of Commons Select Committee on Expenditure. One member of the delegation from that Association informed the Committee that, in a prison—and it was not Grendon or Wormwood Scrubs, which have special units to deal with psychiatric cases—where he worked for several years as a welfare officer, about 11 prisoners on average every year were released after offences for which, in his opinion, and in the opinion of his colleagues, they bore only a very diminished responsibility. They were suffering from some form of mental abnormality and they should not have been sent to prison. That was not only the view of the welfare staff in the prison; it was the view of the prison governor and, no doubt, some of his colleagues.
On that basis, that probation officer computed that as many as 1,000 men and women might be serving prison sentences at any one time, with some form of mental disorder. They were not receiving, or 1847 perhaps were not susceptible to, psychiatric treatment and, in many cases, they were not subject to any control whatsoever on being released. They were serving fixed-term sentences. Normally, they would come out after completing two-thirds of their sentences, and there would be no control once they were in the community. That officer stressed to the committee his difficulty, and indeed his failures, in making any discharge arrangements for the great majority of those 11 men per year who were in that prison; and that figure could be multiplied by the many prisons in which that happens, with the consequent risk which those mentally disordered offenders, having been in prison, present to the public.
Even where such people are subject to supervision orders of some kind or another, whether they come out on parole licence or a young person's licence, they are very often not responsive to the kind of skills that probation and after-care officers and social workers possess. Whatever the numbers—and although I produced a figure of about 1,000, somebody this afternoon gave what sounded like an authoritative figure of 900, or thereabouts which I have not seen myself—it is reasonable to claim that there are very many cases of this kind. Mentally abnormal ex-prisoners present a danger to the public and to themselves, whether or not they are supervised, and even though they may not in all cases be violent people. Because of their disorder, some of them cannot be cured.
A number of questions arise from the evidence submitted to the Select Committee on Expenditure. May I pick out three main questions which raise quite a number of others, but they are very obvious ones. First, should such persons have been prosecuted in the first instance by the police? Secondly, depending on the plea at the trial and how that plea was dealt with, was there a medical report and were there social inquiry reports in every case before sentence was pronounced? Thirdly, depending on the question of reports, should such persons have been sent to prison, and was prison an appropriate form of sentence?
Certainly there is no one answer to those many cases of people who come before the courts in that mental condition. 1848 As I have said, those three questions give rise to a number of others. The answer to the first question, that of prosecution, and to the third question, that of imprisonment, may well have been known in most cases, but—and the "but" means that there was no alternative secure place for such persons to go to; there was no asylum, and I use the word "asylum" not it its old "loony bin" sense but as meaning a refuge or a place of safety where they could be cared for instead of having to be sent to prison, or after having come out of prison.
I have nothing more to contribute to your Lordships' debate, beyond expressing to my noble friend Lord Allen of Abbeydale the hope that the testimony from the Probation Service with which I am concerned adds force to the case which the Committee of the noble Lord, Lord Butler of Saffron Walden, made so extremely cogently and to which the noble Lord, Lord Allen of Abbeydale, has this afternoon drawn our attention with a very strong note of urgency.
§ 5.23 p.m.
§ Lord WELLS-PESTELL
My Lords, so far as I am concerned, the most pleasing feature about the debate this afternoon is to see again in your Lordships' House the noble Lord, Lord Butler of Saffron Walden. I first met the noble Lord more years ago than I care to remember, when I helped to introduce into this country a voluntary organisation which today is perhaps one of the leading voluntary organisations, one that is known not only nationally but internationally. The noble Lord, Lord Butler of Saffron Walden, may not realise that this organisation would have sunk without trace within a matter of three years for lack of money had he not called together a number of business people and influential people and told them of the situation. His action produced so much money that it enabled this organisation to carry on, and today it enjoys a great deal of approval in the eyes of everybody.
I am not unaware that the matter which we are discussing today is a kind of "no-man's-land" which is full of mines and trip wires. However careful one is and however carefully one walks, one is bound either to tread on a mine or to set one off by the trip wire. As it was felt that my 1849 Department would in some respects be criticised, perhaps not without justification, it was thought that at this stage I should intervene to try to answer some of the points which have been made. It was possible to anticipate what certain noble Lords would say, and this they have done. Certainly the noble Lord, Lord Allen of Abbeydale, and the noble Earl, Lord Longford, indicated to me some time ago the line that they were likely to take.
I want to say at the very beginning in answer to the noble Earl, Lord Longford, that the report of the Butler Committee on the urgent need for regional secure psychiatric units was accepted by the Government. There is no intention on the part of the Government to put the report conveniently aside and at a suitable moment to torpedo it out of sight. There are reasons why the Government have not made the progress they would have liked to make.
We recognise that it is important that this recommendation and the programme for providing these units should be seen in the context of the Government's overall strategy for the development of services for the mentally ill and the mentally handicapped, to which we continue to attach a great deal of priority. This is not just a form of words; it is a sincere belief. Indeed, only this week planning guidelines for 1978–79 have been sent to health authorities and local authorities, reiterating the priorities for these services which had been set out—I would say clearly—in previous documents.
Mentally abnormal offenders who are referred as patients to the National Health Service are treated and cared for in respect of their mental disorders in that part of the psychiatric service which is appropriate to the care and treatment they need, including any appropriate degree of security. They are not regarded as a separate category of patient for whom separate services are provided, nor do they all require—this is a point which we have to keep in the forefront of our minds—the same degree of security.
The regional psychiatric secure units which the Butler Report recommended have to be seen against this general background. They form part of an integrated psychiatric service, not a separate and 1850 distinct service. Essentially, they are for patients who require a degree of security less than that of the special hospitals but greater than that of the ordinary psychiatric hospital or unit. It is part of the latter's function to provide a degree of security by means, in some cases, of a high level of staffing oversight and in others by the occasional use of a locked room or ward. Thus, the secure units will take only a minority of patients who are difficult to manage. They are not for all offender patients, or for all ex-special hospital patients, or for any other category of that kind. They are for a limited group of patients.
The noble Earl, Lord Longford, referred to Knowle Hospital and said—and I accept his comment and observation—that there is no locked door and that any of the patients can leave at any time. They would be dissuaded from doing so, and because of the high level of staff at Knowle there is every reason to believe that this policy is successful. Although I have been at some pains to inquire, I do not know of one person who has, for want of a better word, absconded from Knowle. This is due, as I have said, to the high level of staffing oversight.
§ The Earl of LONGFORD
My Lords, would the noble Lord like to finish with Knowle, or may I intervene now?
§ The Earl of LONGFORD
My Lords, may I remind the noble Lord of what I told him: That two-thirds of the people there are voluntary patients. Knowle is not dealing, therefore, with the problem of delinquency.
§ Lord WELLS-PESTELL
No, my Lords, but what is delinquency? Does delinquency apply only to those who appear before the courts? These are people whom it is suspected might well behave in a seriously anti-social way. As I have said, they have gone to Knowle and there they have stayed. I do not know of a single instance of anybody walking out or absconding.
Patients come from a variety of sources. Some patients come from special hospitals, but most special hospital patients who have reached the point where they are ready 1851 to leave hospital should either be transferred to ordinary psychiatric units or be discharged direct into the community. The largest source of patients for secure units is expected to be those who have proved to be beyond the capacity of the ordinary psychiatric hospital or unit to manage, even with a high level of staffing oversight. A further source will be offenders admitted on court orders, but again most of the offenders are envisaged as continuing to be admitted to ordinary psychiatric hospitals or units, at least in the first instance, to see what can be done for them at that level. The other source will be the mentally disordered prisoners transferred on the Home Secretary's order, who have been referred to this afternoon. Once more we would expect ordinary psychiatric hospitals to continue to take a number of such transfers in the ordinary way.
As noble Lords will be aware, progress in setting up regional psychiatric secure units has been—and let me be quite frank about this—disappointingly slow despite the special capital and revenue moneys which have been made available. Ten of the 14 health regions have put proposals to my Department and we hope that the other four will be able to do so very soon. But the noble Lord, Lord Allen, was quite correct. He was very fair—if he does not mind my saying so—in saying that the most we can hope for is that there will be two or three regional units operational by 1980 or 1981 and the rest we hope will be established by 1985. I cannot give your Lordships any assurance whatsoever that we shall be able to do so before then. There are considerable difficulties.
The noble Lord, Lord Allen, referred to the use of the money which we gave. The allocation was first made in 1976–77 and it was repeated for the year 1977–78. It was to enable regional authorities to establish interim facilities to try and close the gap in the service. My department recognised that the amount provided was likely in practice to be more than could be used in the first year. The result was that the authorities were authorised to devote the unspent money to other urgent Health Service purposes. The regions were reminded last year that in the current financial year they should be in a position to put the allocation to the 1852 fuller use and recommend that any allocation unspent on secure facilities should be devoted to other facilities in the psychiatric field.
I have explained at some length the purpose of the units because I suspect that some of the difficulties in getting the units set up may spring from a variety of misunderstandings as to what is happening. My right honourable friend the the Secretary of State for Social Services at a meeting with the chairmen of all the regional health authorities as recently as yesterday discussed with them what must be done and what can be done to speed the progress. The chairmen confirmed their support for the policy but brought to the notice of my right honourable friend the Secretary of State the real difficulties that they are facing. The problems are complex.
The concept of regional secure units is an untried one and-I have to be perfectly frank about this—staff attitudes are also a key factor. It has to be said that the enthusiasm for treating patients under open conditions, with all the benefits to staff and patients in doing so, has led to a situation where many staff are reluctant to treat patients in conditions of security. There also seems to be an increased Unwillingness to treat the very difficult ones who are disruptive or violent or difficult, for reasons which I think most of us here can understand. It is one thing to say to people, "You ought to do this" when you are not doing it yourself.
Public attitudes are also a key factor. Misunderstandings about the nature and purpose of the units, the kinds of patients who will be in them and the risk they represent to the local public are widespread. Every one of us here believes that there should be a regional secure unit, but not next door to us, next door to somebody else. We are having these difficulties. One was raised in your Lordships' House over a year ago where the local community demanded an inquiry and it is not resolved yet because people living in the community will not have the unit.
The Regional Health Authority is in the same position as everybody else. We cannot build where and when we like. We have to get planning permission and we have to submit plans. We have to get authority to do this, that and the other and 1853 if anybody objects, as they do (in two cases, to my knowledge), we cannot do anything until after completion of a long-drawn-out process because the rights of the individual have to be protected. It does not help—not that any Members of your Lordships' House are responsible for this—when people make references in public to "mini-Broadmoors". As the noble Lord, Lord Allen, said, they are not going to be mini-Broadmoors. I am grateful to have this opportunity of saying the things I have said.
§ Lord SEGAL
My Lords, may I interrupt my noble friend? As one who objected very strongly at the time to the Earlswood project, I feel I ought to say that I have now completely changed my mind, partly as a result of the urgency of the problem and partly as a result of the Butler Report. I hope that the Government will proceed with the matter with all urgency.
§ Lord WELLS-PESTELL
My Lords, the noble Lord may have changed his mind—I am glad that he has—but the point is that you have to change a large number of people's minds in these matters before you can get things done. Some noble Lords may have seen the recent papers by Dr. Bluglass, regional forensic psychiatrist in the West Midlands Regions, which he put to an all-Party mental health group. He implies that the Department of Health and Social Services Working Party Report and the Butler Report were not specific enough about the types of patients who would be suitable for secure units.
It is true that my Department's report, which we call the Glancy Report, concentrated on types of patients who would not be suitable for admission, making the particular point that the units were not intended to cope with all the patients in mental hospitals who were sporadically difficult or aggressive but only with those causing continuing difficulty for whom expert and intensive therapy in secure units was likely to produce significant improvement within 18 months to two years. The Department's design guidelines went into more detail about the types of patients for whom the secure services are needed. However, we would accept that further definition may be helpful, but again we are dealing with a very young 1854 science—if psychiatry is a science. I do not know whether it is; it is certainly not an exact science. Any science that is not an exact science very often throws up more difficulties than it solves.
The point is also made that a significant number of patients are likely to require secure accommodation for longer than 18 months to two years as envisaged in the Glancy Report. This is an important issue. It highlights the importance of secure units being seen as only one element in the whole spectrum of different degrees of security. I want to stress this point—different degrees of security. I think we are making a very serious mistake if we think that a secure unit must be a place that is completely isolated from anywhere else, that is bolted and barred and locked. I do not think that that is conducive to helpful treatment.
I am simply trying to reply to some of the remarks that have been made about my own Department. I do not want to go on any longer, because the brunt of this falls on my noble friend Lord Harris. I should like to make one other point: that is, that we are so concerned about the problems which seem to bedevil this whole question of safe security units that we have had our policy endorsed by all chairmen of the Regional Health Authorities. I am glad to say that we have bad our policy endorsed by al I the professional bodies, including the Royal College of Psychiatrists, and also by the TUC and the national trade union organisation.
My right honourable friend has set up a committee which includes representatives of the whole trade union movement affected here; he has their support and we are hoping that they will be able not just to consider the difficulties with which we are faced but to provide solutions which will help us, once we have got through all the tedious problems of planning, siting and all those other things, to see that we are able to get the staff to meet the requirements of the Butler Report.
§ 5.42 p.m.
§ Baroness FAITHFULL
My Lords, all those in the Prison Service, in the Probation and After-Care Service, in the Health Service and the voluntary and statutory social services, and indeed the mentally abnormal offenders themselves, 1855 owe a debt of gratitude to the noble Lord, Lord Allen of Abbeydale, for initiating this long and overdue debate. It seems almost presumptuous to pay tribute to the noble Lord, Lord Butler, and his colleagues for producing a masterly and readable report on an extraordinarily wide-ranging and complex subject.
Mentally abnormal offenders are individuals who in our society are unacceptable to many, and indeed by many they are feared. They cannot be brushed aside; indeed it would not be politic to do so. As Lord Allen said in his opening speech, in a civilised society they should, surely, receive caring treatment, while at the same time protecting the public from their intermittent dangerous behaviour.
I would ask a few questions. First, may I draw the attention of your Lordships to the recommended provision for mentally disordered juveniles and young adult offenders. This is outlined, and the problems are outlined, in Chapter 17 where it says:Placement within the prison system is not appropriate for juvenile offenders suffering from mental disorder. … We recommend that steps be taken by the DHSS to encourage the establishment of more places in hospital for mentally disordered juveniles and we hope that increased facilities will promote greater willingness on the part of consultants to accept them".—[Parapraphs 17.2 and 17.3.]There is much concern in this country over juvenile offenders requiring secure accommodation. On 20th June 1975, there was a ministerial Statement in the other place that the Government intended making available to local authorities financial assistance in the form of grants for the purpose of building secure accommodation for seriously disturbed juveniles. May I ask the Minister to what extent that Statement, made 2½ years ago, has been implemented? For a juvenile a time in prison can be a passport to further crime and further difficulty.
May I ask the Minister, also, whether any hostels have been set up for the after-care of such juveniles? This was a recommendation in Paragraphs 134 to 139. I was going to ask various questions on the regional secure hospital units, but the Minister, the noble Lord, Lord Wells-Pestell, has answered the questions I was going to ask. I should like to say that I was privileged to sit on a committee in the 1856 Oxford region which first discussed the setting up of these units, and I echo what the noble Lord, Lord Wells-Pestell, has said: there are untold difficulties over the setting up of such units. One of the greatest difficulties, perhaps one of the sadnesses and tragedies of our time, is that everybody in an area agrees that they should be set up, but not in their area.
We should ask ourselves—and I would put this before your Lordships' House—in what way can we change public opinion in a civilised society in regard to people who are so mentally ill and mentally handicapped that help is needed, to persuade people that instead of being fearful, frightened and appalled by them, they should seek to help them and co-operate with those wishing to do so. I would also echo what the noble Lord, Lord Wells-Pestell, has said over staffing. I have worked in a mental hospital. It is very difficult for staff to accept work in a mental hospital that is secure and not open. I hope that we may have the co-operation of the trades unions. Their rôle is to safeguard their staff, and many of their staff are fearful. Also, I would suggest that it is a trade union's privilege to help its members to understand the need of the patients that we are dealing with. I hope that they would also join with the rest of us in doing what we can to change the public attitude towards people who are so much in need of skill and help.
I should like to take up a point which the noble Lord, Lord Butler, made on the question of social services and aftercare and preventive work. I would ask the noble Lord, Lord Wells-Pestell, or the noble Lord, Lord Harris of Greenwich, whether we should not be considering the question of the training and the role of the Probation After-care service and the training of social workers in the statutory and voluntary social services. I would ask the Minister to inquire of the Council on Training and Education in Social Work if that Council is satisfied that the universities and polytechnics are supplying the right type of training for probation officers and for social workers, training enabling them to work in the field of mental health.
I have been told by some senior probation officers and senior social workers that they are concerned that the present courses for some probation officers and 1857 social workers do not begin to equip them for work in this field. Yet again—and I almost hesitate to do this—may I bring to the notice of the noble Lord, Lord Harris of Greenwich, a request that I have brought to him on at least two other occasions for adequate community social services, and in particular the need for hostels. It is cheaper to provide hostel accommodation than for an offender to return to prison, or even to go to prison in the first place.
I had a friend called Joe, and he used to call a week before Christmas and ask whether he could see me to wish me a Happy Christmas. I used to say: "Joe, it's a week before Christmas, why not come round on Christmas Eve?". He used to say, "I have business to do tonight". That business was to clock a policeman, knock him out, appear before the magistrates and to be sentenced to time in prison, so that he could have a Christmas dinner. That does not happen now in the area in which I live, because we have a Church Army hostel, a Salvation Army hostel, and a Cyrenian community who, among other organisations, take in those unsupported by anyone else, but on whom some mental hospitals rely.
I should perhaps add that there are mentally abnormal offenders and non-offenders who can sustain life in a hostel or in the community if they receive a daily domiciliary visit from a nurse they know from the hospital who encourages them to take their medicines and who gives them support. That, with the support of either the probation officer or the social services worker, is able to sustain them. I cannot and indeed dare not embark upon the imponderable dilemma which contains conflict for both the Judiciary and medicine. However, I would join with the noble Lord, Lord Winstanley, and ask the noble Lord, Lord Harris of Greenwich, when we are to have the White Paper on the Mental Health Act 1959.
There have been debates in your Lordships' House on overcrowding in prisons. There are 347 prisoners in Oxford Prison which was built in the last century for 163. We have heard of gross overcrowding in the special hospitals. We have had debates in your Lordships' House on alternative community care and after-care of offenders and non-offenders 1858 who suffer a mentally abnormal condition. We have heard of the anomalies as between the administration of the Mental Health Act and the responsibility of the Home Office and the Department of Health and Social Security.
Has the time not come for establishing a national advisory board with representation from all the interests involved—as recommended on page 266 of the report—to work out a concerted policy, and for such a body to assist towards working out solutions? I ask the Minister, the noble Lord, Lord Harris, whether his right honourable friend the Minister in another place would, in deference to the noble Lord, Lord Butler of Saffron Walden, following this debate launch a combined operation—"Operation Butler".
§ 5.54 p.m.
§ Lady KINLOSS
My Lords, the noble Lord, Lord Allen of Abbeydale, paid tribute to the noble Lord, Lord Butler of Saffron Walden, for his profound and excellent report. I should like to join him in that tribute and also say how clear and interesting I found it. It is certainly high time that this report, published as long ago as October 1975—two and a half years ago—should receive what is long overdue debate. If the people concerned in this report, the mentally abnormal offenders, are not numerous, they are persons who especially deserve our compassion. At the same time, either because they are a present and active danger to society, or because they are a potential danger to their fellow men and women, consideration of their treatment is imperative and urgent. Truly, we should not have delayed discussion of this report for so long.
I am very sorry that the right reverend Prelate the Bishop of Chelmsford is unable to speak today. I had been looking forward to hearing what he had to say. As I read the report of the noble Lord, Lord Butler of Saffron Walden—paragraph 1.1 (b) of which refers to treatment in prison, hospital or the community—I could not help noticing that there was no reference made to pastoral care by such chaplains as there may be or of pastoral care when they return to society, although the report laid great emphasis on after-care, with which I entirely agree.
1859 Although in cases of restricted release under Section 65, after-care is compulsory, there is a lack of suitable hostel accommodation for such cases. I trust that the Government will be able to look at this matter sympathetically. As the Butler Report suggests, close co-operation between the social workers in special hospitals and the local authority social worker is an essential ingredient, and after-care should devolve upon either the social worker or the probation officer, whichever of the two in each individual case is known to have had the greater contact with the patient.
There seem to be conflicting interests within the administration in this matter—the proper sphere of psychiatrists, of medical treatment on the one hand, and of the public security on the other, which is essentially the role of the Home Secretary. Looking at the literature at my disposal, it seems to me that not always are these two things properly harmonised. However, the curative intentions of the doctors and the custodial purposes of the Home Secretary should, I should have thought, have the same aim: the single intention of helping mentally abnormal offenders to return to a normal and decent place in society. I ask myself whether, in fact, this educative process is helped by the present administration of the 1959 Act. In what I have to say, I do not blame any one Government, for it appears to me that the present situation has existed for a very long time.
It is a truism that any cure, of whatever disease, depends to a given extent on co-operation between patient and doctor. Hope is the essence of the cure, and it is that alone that the doctor can hold out to the patient as the light at the end of the dark tunnel of mental illness. But even when the responsible medical officer—or RMO as he is commonly called—has recommended discharge of a patient, and this has been followed by a similar recommendation of the review tribunal, the Home Secretary can refuse to accept the advice without giving any reason. I am greatly perturbed that in no fewer than 40 per cent. of cases under Section 65 of the Mental Health Act in which tribunals have recommended discharge, between 1970 and 1975 the Home Secretary rejected the tribunals' advice, and again, of course, without giving reason. Even then, if a 1860 restricted patient has been conditionally, discharged, the Home Secretary, again without having to give a reason, can recall that patient to hospital at any time. The organisation MIND took to the European Commission on Human Rights the case of a man who was recalled to Broadmoor after three successful years of normal life in the community, solely on the evidence of his wife with whom he had had a matrimonial dispute.
However, it is not only the wholly arbitrary nature of the Home Secretary's powers with which I am concerned, because there are also the administrative delays to which patients are subjected. The RMO may tell the patient that he recommends his return to society, yet there is evidence of cases taking the Home Secretary up to a year or more to make a decision. It can be that the Home Secretary refuses, again without any reason given, and does in 40 per cent. of cases. In one case that has been reported a patient recommended for conditional discharge by his RMO was kept waiting for two years. Understandably he suffered acute anxiety and, sadly, his marriage broke up. He suffered also the constant worry that the job and accommodation he had been offered would be lost. It is possible to cite other cases. One wonders how many relapses are caused by these administrative delays. With a 40 per cent. difference of opinion between 1970 and 1975 between responsible doctors and tribunals and the various Home Secretaries, one is obliged to ask why it turns out that the doctors and tribunals are found wrong in nearly half the cases. Why is it, if the doctors, who have personal knowledge of the individual patients, are wrong in so many cases, that the Home Secretary is not wrong also?
Allow me, my Lords, to cite the European Convention on Human Rights. It says:Everyone who is deprived of his liberty by arrest or detention shall be entitled to take proceedings whereby the lawfulness of his detention shall be decided speedily by a court and his release ordered if the detention is not lawful".Under the law as it stands in England a patient is deprived of all such rights. Is it truly just that he should continue to be deprived? Is it truly just that on the say so of one man—the Home Secretary—he can be denied access to a tribunal when his discharge has been recommended by 1861 his RMO? Is it not time that the law is amended?
After visiting Broadmoor yesterday I could not think that any of the responsible medical officers who I met—nor indeed any other doctor—would irresponsibly recommend the discharge of patients not tit for discharge. The devotion of the staff, doctors, nurses and equally the ancillary staff moved me deeply. May I say how much I value the privilege of having been permitted to see it for myself.
§ 6 p.m.
§ Lord GARDINER
My Lords, I, too, should like to thank the noble Lord, Lord Allen of Abbeydale, for enabling us to discuss this important report this afternoon. We are all, of course, greatly in the debt of the noble Lord, Lord Butler of Saffron Walden, and of his Committee. I sometimes think that we do not thank enough those men and women who voluntarily and without reward spend so much time and get so little lunch. It is perhaps a reflection on the House that we have not considered this report before.
I confess that in my very old age I am reaching the conclusion that Governments would do better if they appointed rather fewer Royal Commissions and committees and paid rather more attention to the reports they receive from those they do appoint. This has, I think, particular force at the moment when we have recently seen a Royal Commission appointed to inquire, among other things, into two subjects, both of which have already been considered by two or three separate committees; now a Royal Commission is to consider the whole matter all over again.
If I may, I shall confine my remarks to the effect which these reports have on the difficulties experienced by the judges, the courts and also the prisons in this area. One has, of course, to consider both the special hospitals and the general psychiatric hospitals. The position in the special hospitals was well described in the Butler Committee's Interim Report, in paragraph 4, as what they found to be the appalling conditions in the special hospitals. I shall not take up time in reading it. My noble friend Lord Harris of Greenwich may agree that the position, which is in no way the fault of the special 1862 hospitals, is still as difficult now as it was then. They are greatly overcrowded and there are two difficulties which conflict with one another.
The first is that there are a number of patients who do not need the exceptional security provisions of the special hospitals but who cannot be left free in completely open hospitals; however, they would be quite all right in the secure units of an ordinary psychiatric hospital. On the other hand, there are those in prison who ought to be in a special hospital but who cannot be there due to lack of space. I would venture strongly to support the need for secure units. As has been said by my noble Baroness Lady Kinloss, these ought to be subjects for our compassion. I do not see my noble friend Lord Longford present. I have not infrequently agreed with him, but on this occasion I was surprised. I entirely agree with my noble Baroness Lady Kinloss that these people deserve our compassion. They are mentally ill; they are not so dangerous that they have to go to a special hospital. They need treatment and would improve with treatment. They cannot receive treatment in prisons for the reason explained in the report; they need somewhere to go where there is a secure unit, but do not need the degree of security present in the special hospitals. For too long now we have denied them that opportunity.
That leads me to say a few words about the time scale. It was in 1957 that the Report of the Royal Commission on Mental Illness commented on this problem and said that what they called "special accommodation" should be provided in general psychiatric hospitals. It is clear from what they said that they were referring to what are now known as secure units. That was 21 years ago. The Mental Health Act 1959, with its open-door policy, may have been a very good thing for all those who are mentally ill and who are not likely, by reason of their illness, to commit criminal offences. However, it did not improve the position for the prisoners.
In February 1961 there was the report—which is referred to in the Report of the Butler Committee—of a working party set up by the Ministry of Health. What they said appears at paragraph 20 of the Interim Report of the Butler Committee. I quote from the 1961 report: 1863Regional hospital boards should arrange their psychiatric services so as to ensure that there is a variety of types of hospital unit, including some secure units".It is not that nothing happened, because only two or three months later the Ministry of Health issued a strong recommendation to hospitals to implement that proposal. But unfortunately nothing happened at all and there was still no secure unit. That was 17 years ago.
Indeed, up to 1974 nothing whatever had been done. The effect of all this on the judges, the courts and the prisons is described in paragraphs 6 and 7 of the Interim Report. After setting out the circumstances, it says in paragraph 5:Two consequences follow from this: one is that many patients in the special hospitals need not be there for reasons of security; and the special hospitals have to refuse admission to cases they could appropriately accept if they had room.6. These problems rebound on the courts and the prisons and they are likely to increase as treatment of psychiatric cases is developed in district general hospitals. The courts are experiencing more and more difficulty in dealing with mentally abnormal offenders who need psychiatric treatment but who must be kept in secure conditions …7. Evidence received from the Home Office and from members of the Prison Medical Service has indicated growing concern among those responsible for the administration of the prisons about the increasing numbers of mentally abnormal offenders in the prison population. Despite overcrowding, the prisons have no choice but to accept the offenders sent by the courts, including the mentally abnormal people who are sentenced to imprisonment, for want of acceptance by a hospital".Increasingly, the judges have decreased the number of cases in which they make hospital orders with a restriction because they found it absolutely useless to do so, for no one can find a hospital which is prepared to take such people. They cannot be sent by a judge to a hospital for treatment unless the hospital agrees to accept them.
It took more than two years before the Government, in relation to this report, said anything except that the matter was under consideration. I observe that when Questions are asked about mentally abnormal offenders in the other place it seems to be a matter of chance whether they are answered by a Minister of State from the Department of Health or by a Minister of State from the Home Office. 1864 However, in all this time I have seen no sign of the two Departments not cooperating very well together; they appear to me to have done so.
Naturally, I was delighted when, on 25th April last year, in a Written Answer the Minister of State in another place said:We [the Government] accept that the provision of a secure unit in each health region must be a matter of high priority, and … have provided support both for their capital and running costs".I am delighted to hear from my noble friend Lord Wells-Pestell that the Government have no intention of going back on that or of dropping it in any way. I appreciate the difficulties. I confess that I thought from what was said at first that some of the hospital authorities had taken the money and then embezzled it, but I gather that it is not as bad as that, though why they were allowed to spend the money on something else I do not quite know. I appreciate the difficulties of staffing, and so forth. This is really a matter for educating both those psychiatrists who are not forensic psychiatrists, and also no doubt the working staff. I am glad to hear that appropriate negotiations are going on with the trade unions concerned. Therefore, while it may have taken a long time I respectfully applaud the decision which the Government have now taken to provide, as soon as they can, secure units.
May I ask my noble friend Lord Harris whether I am right in thinking that today there is no secure unit at all? This is after a total of 21 years. If that is right, may I ask him what buildings are in train? Are some being started to be built? If so, how many and where? When are they likely to be completed? Most important what is their capacity? The Butler Committee calculated that there were about 900 prisoners who, instead of being in prison, ought to be in secure units, and that, allowing for people detained who were not prisoners, a total of some 2,000 places ought to be provided.
Lastly, might I ask whether I am right in thinking that there is no power at all for the Government to force regional hospital authorities to provide one psychiatric hospital in their area with some quantity of secure units? If there is no such power, do the Government—because they, after all, are providing the money—contemplate legislation to require it? Even regional hospital authorities are to 1865 some extent under the rule of law and under Parliament. Do the Government contemplate legislation to provide, having been given about 17 years, some time limit in which, if they have not taken some steps to produce secure units in one regional hospital in their area, Parliament may decide that they shall?
§ 6.12 p.m.
§ Lord AUCKLAND
My Lords, when some several weeks ago the noble Lord, Lord Allen of Abbeydale, asked me whether I would speak on this subject, I agreed with some trepidation. The trepidation still remains because this is not an aspect of the mental health service with which I come into much contact. My own contact, like that of many noble Lords and Members of the other place, has been with mental hospitals as such as opposed to the special hospitals. The noble Lord initiated this debate with a clear and convincing speech, and the ensuing speeches have followed that pattern, particularly the speech by my noble friend Lord Butler of Saffron Walden who, I am sure we all recognise, has produced a masterly report.
It is certainly a lengthy document, preceded by the interim report which I must say makes slightly easier reading, but the report as a whole is a valuable one. Of course with the economic situation that this country faces and has faced for some years under all Governments, and which it is likely to face in the future, the prospect of any major implementation of the report as a whole in the short term must be considered remote. Nevertheless, we all hope that as a result of this debate it will be possible for at least some of the major recommendations, particularly the provision of the new special hospitals, to be expedited.
The Mental Health Bill, as it then was, seems a long time ago. I recall that I made one of my first speeches in your Lordships' House on it. The Act, as it now is, is an impressive piece of legislation, despite the undoubted flaws which it may have. Any Act of 154 sections and 8 Schedules is bound to contain sections which, in retrospect, may be regarded as perhaps rather unworkable or surplus to requirement, or perhaps in some cases the opposite. But I believe that the Act has been a stepping stone to a good deal 1866 of progress in the mental health field; both in the general mental and psychiatric hospitals, and also in the special hospitals.
One of the great problems which the report highlights is that of overcrowding. The interim report, in paragraph 4, talks about the visit which the Committee made in, I think, 1972–73, which is 6 years ago. There may well have been improvements since then. If there have been I have no doubt that the noble Lord, Lord Harris, will correct me and other noble Lords who make this point. The paragraph says:On our visits to the special hospitals it is not too much to say that we have been astonished and shocked at the over-crowding, particularly in Broadmoor, where in some wards the beds, in rows right across the room, are no more than 18 inches apart".Eighteen inches apart! I must come clean here and say that I have yet to visit one of these special hospitals. I hope that the opportunity will come, because I think that it is something which all people in public life who have a genuine interest in these unfortunate people who suffer from mental disorders should particularly undertake.
But the alarming thing here is that it is not only in special hospitals that this terrible situation arises. Where I live near Epsom, we have six or seven mental hospitals staffed, as I have said before and I make no apology for saying again, by devoted people; but the overcrowding in some of these hospitals, particularly among the geriatric persons, is really very distressing. Here I think that the question of after-care really arises, because if this report means anything I believe that it is to the future that we have to look. It is fine to know that the new Park Lane Hospital is at least in the process of being built, whenever its completion date may be. The projected date is 1982. But it is not merely a question of bricks and mortar; it is a question of staffing. Where the problem really arises is throughout the National Health Service as a whole, whether it be general hospitals, mental hospitals, or special hospitals.
An interesting publication which the organisation MIND put out made the important point—I do not necessary agree with all their conclusions, but they submitted a valuable and sincere report—that despite any success one may have in this field, when there is a case of ill-treatment 1867 or something of that kind it is very much highlighted by the media. I do not necessarily quarrel with that, provided the facts are right and the impression is not given that those who staff these hospitals, in whatever capacity, are out to treat patients unkindly. Whether they are psychopaths or schizophrenics—and not being a medical man I am not qualified to tell the exact technical difference between the various terms—one thing is certain; that is, that these people are all mentally and in many cases physically ill, and that in some cases they need attention round the clock, whether in general psychiatric hospitals or, even more so, in special hospitals.
We must also consider the question of therapy. I have not given the Minister notice of this question so he may not be able to reply this evening: in these special hospitals—Broadmoor, Rampton, Moss Side and, in Scotland, Carstairs—how much attention is given to therapy, occupational therapy and so on? One recognises the difficulties here because in many cases these people must be very closely guarded and are dangerous, but I suggest that in some cases some kind of occupation in the hospital would alleviate many of the tensions which undoubtedly arise.
On the question of rehabilitation, one must bear in mind the two types of behaviourism, so to speak, one being in the home; if they are sent back home to their families, if there families will have them, after perhaps they have had several years in institutions, they go home to a very different environment and that must have a bearing on their behaviour compared with when they were in hospital, where they were guarded and looked after; they knew their nurses and they had security, even though, as noble Lords have said, the conditions under which they lived were not as comfortable as we would like to see.
It is good to know that a White Paper will be coming out, and I take the point which the noble Lord, Lord Butler of Saffron Walden made on the question of revenue from North Sea oil and how it should be spent. I believe the social services should have a very high priority, particularly in the sphere of mental health. The kind of people about whom we are talking may in some cases never be able adequately to take their place in society, 1868 but they are still human beings in need of constant treatment and sympathy. In other cases there is the possibility of some form of rehabilitation. I end by again paying tribute to Lord Allen for having initiated this debate because, notwithstanding the important and in some cases disturbing national and international affairs which surround us, any subject which concerns human beings as directly as does this debate is of major importance.
§ Lord WELLS-PESTELL
My Lords, perhaps I may intervene to say that in a debate of this kind, in which two Departments are involved, with your Lordships' permission I propose to read very carefully all the speeches that have been made since I sat down and to deal with any point by correspondence. I think it would be quite unreasonable in the circumstances to expect my noble friend Lord Harris of Greenwich to be able to reply for the DHSS.
§ 6.27 p.m.
The Countess of LOUDOUN
My Lords, as I am speaking towards the end of the debate, most of what I wanted to say has been said, but I intend my remarks to be short and, though I may repeat some of what has been said, I think it bears repeating. It is now two and a half years since the Butler Committee produced its final report, in which it expressed concern that no progress had been made in establishing regional secure units in the National Health Service. That was generally considered to be due to lack of funds. Since then a considerable amount of money has been set aside by the DHSS specifically for this purpose, and I am pleased to have the assurances of the noble Lord, Lord Wells-Pestell, on this issue.
According to the information I have been given, interim secure units have been established in three hospitals: at Knowle Hospital Fareham, which opened in January 1977; at Prestwich Hospital, Manchester; and at Rain Hill Hospital, Liverpool. Prior to 1959, most mental hospitals had locked wards. Offender patients and difficult non-offender patients who were a problem of management and required some degree of security, but not to the level of that provided by the special hospitals, were easily managed by nursing and medical staff, who had considerable skill in this field.
1869 However, with the introduction during the 'fifties of the policy of unlocking doors and dispensing with restrictive methods of care, brought about by the discovery and use of a new range of psychiatric drugs, a new approach was necessary. Today, although there is some acceptance by the professions of the proposals for secure units, this is not unanimous and there is widespread misunderstanding and concern about their purpose and the types of patient for which they will cater. The White Paper on Mental Illness made a positive statement on which kind of patient should be admitted to a regional secure unit:… patients who are continuously behaviourally disturbed or who are persistently violent or considered a danger to the public, albeit not an immediate one".There is also the belief nowadays by some people that all difficult patients will be accommodated in secure units and that the National Health Service psychiatric hospitals need have no further concern with their problem. But that is not so. Special hospitals are finding it increasingly difficult to obtain beds in NHS hospitals for recovered patients who are not now dangerous but who require rehabilitaton near to their homes.
In turn, psychiatrists and prison medical officers who consider that an accused person requires a hospital order, find it increasingly difficult to obtain accommodation in National Health Service or special hospitals, with the result that prisons now hold some hundreds of offenders who should be in hospital, and though recommendations for transfer from prison to hospital are made, these rarely take place owing to the increased resistance on the part of psychiatric hospitals to admit thse people. Special hospitals are overcrowded, many of their patients having no need for such secure conditions. But where is the alternative? Any plan to develop secure units should envisage a high turnover of patients, with the aim of keeping them for as short a time as possible, with regular reviews being made in all cases. There must be easy movement between the units, the special hospitals, and the National Service hospitals. This is essential to the success of the scheme.
Much of the present problem is created, by a fairly large group, the embarrassing or unrewarding patients, who are not 1870 dangerous, but are often difficult, un-co-operative, uncontrolled, and asocial; those who may drink, take drugs, upset other patients, or break institutional rules. Previously they would have been given "asylum"—and I use the word in its best meaning—by the mental hospital, but now they are increasingly rejected. Secure treatment facilities are required for a small proportion of patients who present difficulties in management, but not for the majority. Planning should concentrate more upon developing services and improving their interdependence. Regional secure units alone will simply create new problems, unless their relationship to other services is more clearly defined and understood. Perhaps now is the time for a national advisory body to be set up, as recommended by the noble Lord, Lord Butler of Saffron Walden,to report where problems are arising, and to assist towards solutions".
§ 6.32 p.m.
§ Baroness STEWART of ALVECHURCH
My Lords, first, I should like to thank the noble Lord, Lord Allen of Abbeydale, for initiating the debate, and to say how much I have learnt from it. Like many of your Lordships, I read with much interest the report on Mentally Abnormal Offenders, and I thought that it dealt both realistically and in depth with problems which concern us all, and it is certainly my hope that many of its recommendations will be given priority by the Government in the not too distant future. I believe that we must bear in mind that, in a progressive country such as our own, the higher the standard of our social services, the more critical of them we become. It is only in quite recent years that we have become aware of the widely different needs of mentally abnormal offenders.
Those about whom I have some firsthand knowledge are juveniles who in past years we have dealt with in juvenile courts, and I should like to restrict my comments to their needs. I wholly agree with the statement made by the Association of Heads and Matrons of Community Schools, in its evidence to the Butler Committee, that when dealing with disturbed and anti-social young people, we should avoid attaching labels to them, such as "psychopathic disorder". What 1871 we should do is to try to understand their needs and viewpoints as individuals; and it is to the needs of young, disturbed people that I think we should give priority if we wish to reduce not only their number but also the number of abnormal adult offenders in our community today.
The provisions for young people who are both mentally disturbed and antisocial are, as the Butler Report says, totally inadequate. One urgent need is for more secure units where young people can both be assessed and receive treatment. The report suggests—and this I agree with—that sonic of these secure units should be attached to existing community homes, and should share the same staff, so that the young people could move gradually from closed to open conditions without interruption of personal relationships with the staff and those of their own age group. But I would urge that these closed units for young people should not be as prison-like as some of them are today. Although the doors and windows must be secure, the walls should be decorated, and the furniture and the lighting should be adequate, and the young people should be provided with occupation that has meaning for them and which serves some useful purpose to other people, as well as themselves.
I know that the problem is a difficult one, particularly in short-stay units in which there are many security problems. One must always bear in mind that in the hands of disturbed delinquents harmless instruments may become dangerous weapons. Also, in short-stay units there are likely to be wide differences in the degree of mental disturbance in the young people concerned. But voluntary societies might well be able, and willing, to make helpful suggestions and contributions in this field of occupation for young people in these units. I am convinced that high priority should be given to the provision of useful occupation for young people in all types of closed accommodation, whether it is prison, borstal, hospitals, or community homes. Although the provision of such occupation for the young inmates would be costly, it would, I believe, lead to greater co-operation and understanding on their part, and would lead ultimately to a reduction in the number of adult offenders.
1872 The Butler Report suggests that some of the additional closed units required for the treatment of disturbed juvenile offenders should be provided on a regional basis. This suggestion I would certainly support, provided that it leads to a more equitable distribution of these units throughout the country. One of the problems relating to these units for disturbed juvenile offenders is, as noble Lords have already suggested, that they may arouse the fear and hostility of citizens living in the neighbourhood. But suitable sites, which are neither unduly isolated, nor too prominent in a built-up area, are more likely to be found if povided on a regional basis.
Lastly, I should like to comment on the use of the word "subnormal" in the assessment of the intelligence of juveniles and adults. It is a most unfortunate word in that it implies that those who are given this label are inferior to those around them, and that they will remain so for the rest of their lives. Such a label is a tremendous handicap to young people, since their progress depends so much on encouragement and self confidence. I should like to suggest to my noble friend Lord Harris of Greenwich that the word "subnormal" should be replaced by one with less unfortunate associations.
§ 6.37 p.m.
§ Lord SEGAL
My Lords, even at this late hour I should like to join with other noble Lords in thanking the noble Lord, Lord Allen of Abbeydale, for giving us the opportunity of debating this most important subject. The debate also gives me an opportunity, for which I am most thankful, of paying a tribute to the medical officers and the nursing staffs who have entered the service of our special hospitals. I can imagine there are few less attractive, and more daunting, prospects in the whole field of medicine. They have to take decisions affecting the safety and lives not only of their patients, but of people in the surrounding countryside, and, as the cases of Graham Young and others have shown, affecting the lives of the whole community. They are themselves at constant risk of personal violence and physical injury to a degree which hardly applies to any other branch of medicine. Theri decisions are subject to the widest possible public scrutiny, and when arrived at from the highest of motives, they are, even if 1873 absolutely correct, liable to gross misrepresentation and newspaper condemnation. If a rare human error has been made—and which of us is exempt from human error?—the repercussions are potentially so serious that no limit can be laid to them.
With all the wide range of prospects that are open to any doctor, I feel that only the strongest sense of social responsibility and of public duty could ever lead a doctor to devote his life to joining the medical staffs of our special hospitals. Hardly less a sense of social responsibility is demanded of their nursing staffs. Even if they do not have to take the ultimate decisions, they have to live constantly with the patients and are subject to perhaps even greater risks. No tribute too high can be paid to their sense of devotion and loyalty to the interests of the community as a whole. I should like to ask my noble friend who is to reply whether he would be good enough to let us have some details, if not now perhaps later on, about the recruiting situation of both the medical and the nursing staffs at our special hospitals. I should imagine that the shortages must be particularly acute.
The 140 recommendations of the Butler Report cover so wide a field, and many of them are of such excellence, that in a debate of this kind it is possible to deal with only a very few points; and, if I confine my remarks to the special hospitals, that is a wide enough field in itself, and I have time to touch on only a few aspects of them. In general, may I say that many cases of genuine grievance, even of glaring injustice, appear in a totally different light once they are properly understood by a direct approach on the spot, by an interview with the patient himself, and an explanation of the other side of his case by the medical officer, on whom the responsibility for his welfare has to rest. Of course, deprivation of liberty is a dreadful thing, whether of the mentally ill offender or even of the mentally ill; but it is incumbent on the community to make the conditions in our mental hospitals as tolerable, as conducive to proper treatment, and especially as flexible, as we can possibly make them. That is why I am particularly glad of the recommendations that secure hospital units should be established on a regional basis and that the cost of them should be met from central Government funds.
1874 These regional units need to be made, often in the teeth of uninformed public opinion, by an informed public minority; and I should like to see any future Government go ahead with their plans step by step, first in the North-West, then in the North-East, in the Midlands and the South-West, or in any other area where the need is greatest, to cope with the overcrowding at Broadmoor and create the local links which are so essential. Here, may I say how glad I was to hear about the new Park Lane Hospital. Shorn of any connection with private hospitals supported by the oil sheikhs of the Gulf, the name alone should give the hospital a good start; and it might well be an advantage if Broadmoor Hospital also could be renamed, just as the old Cancer Hospital was renamed, and called instead the Crowthorne Hospital, or by some other such name, which could divest it of its ill-starred and all too familiar image.
Here, too, may I confess that the Butler Report has led me to change my previous attitude to the Earlswood project at Redhill. Under proper security safeguards, there is an urgent need for the new security units to be sited as near as possible to established hospitals where facilities for treatment and research already exist. I hate the term "medium secure unit", and wish these secure units could be made as flexible and adaptable as possible. This can be done only by prolonged observation, perhaps even by trial and error, on the part of understanding and experienced medical officers. They have to work closely with the Mental Health Review Tribunals, who must also have a clear insight, even as intelligent laymen, into the pathology of mental disease, with all its implications for the patient's family as well as the patient himself. Perhaps the wisdom and experience of the Crowthorne Hospital staff can be lent for training purposes to the regional secure units, once they are established.
Mentally abnormal patients show such a kaleidoscopic variety of personality complications that years of experience are needed on the part of the RMO, in addition to his basic humanity, which must be taken for granted, before a decision on their future can be reached. Here, the personality of the RMO is of paramount importance. His conditions 1875 of work must be rendered as helpful as possible. His periods of study leave, especially in English-speaking countries abroad, must be encouraged. Everything ought to be done to protect the RMO, as well as the patient, from the risk of becoming institutionalised. Here may I say how I was struck at Crowthorne by the small population of coloured patients and the occasional references to the word "repatriation". Could my noble friend touch upon this in his reply? I realise that it is a delicate problem where that world "repatriation" is used for the able-bodied normal citizen: how much more is it liable to misinterpretation in the case of the coloured patient who is mentally ill! I recall a visit to a hospital for the mentally ill in Nigeria some years ago, where we were told that its surrounding barrier was not to prevent the patients from escaping, but to prevent others outside from breaking in. Perhaps that is an ideal we ought to aim for in this country.
I rather like the description, given in a report of the South-West Regional Health Authority, of what a regional secure unit might be,a cheerful community, therapeutically orientated, combining as much of a homely atmosphere as can be contrived, with an unobstrusive barrier that will restrict the residents' freedom to wander off at will"—and, may I add, also with a local identity which would be therapeutically helpful in establishing links with the local community. I believe that such a goal is not utopian. I believe we are edging slowly towards it now, and that one day it will be attained.
§ 6.48 p.m.
§ Lord HARRIS of GREENWICH
My Lords, I should like to say at the outset what a valuable, indeed stimulating, debate this has been, and I think it is right to say on behalf of us all how grateful we are to the noble Lord, Lord Allen of Abbeydale, for having initiated it, and indeed to all noble Lords who have participated in it. The noble Lord, Lord Allen, has a high degree of expertise in these matters, not only as a former Permanent Under-Secretary at the Home Office but also of course because the position which he had some time before 1876 that in dealing with what is now the Criminal Law Department of the Home Office; and I will, if I may, deal rather later with a number of detailed points which he put to me in that particular area.
I think it it is also right to say how glad we all were to have the opportunity to hear the noble Lord, Lord Butler of Saffron Walden, today; he made a vigorous speech. Again, I should like to deal with a number of the points which he raised. I think he was savage to the Home Office, his old Department, on only one issue, and that was on the quality of the pork pies provided by the Home Office when he was Chairman of the Royal Commission. I would say only this to him, that I take note of that point. I am glad to say that I was not in the Home Office at the time; nor was the noble Lord, Lord Allen of Abbeydale, Permanent Under-Secretary. But I take note of the noble Lord's remarks on this matter, and I will gladly draw them to the attention of the Home Office to ensure that the Chairman of the Royal Commission on Criminal Procedure is not enabled to make a similar complaint in the future.
Normally on these occasions I try to deal with a substantial number of points of detail which have been raised. Unhappily, I shall not be able to do so to the same degree on this occasion because I want to deal with a series of points of substance in this matter, and also to indicate a number of our provisional I conclusions about some of the recommendations of the Butler Committee. That being so, I think I shall not be able to deal with the points raised in as much detail as I otherwise would have done. May I apologise for that. I can assure the House that my noble friend Lord Wells-Pestell and I will deal in correspondence with these particular points of detail which have been raised.
Before I begin to make any particular point of detail I should like to start with two general propositions—and one of them was anticipated by the noble Earl, Lord Mansfield—dealing with the Government's response to the report of the Butler Committee. First, there is the question of resources and priorities. The economic situation has prevented the Government, and would have prevented any Government, from doing many of the things they would ideally have liked to do. 1877 Many of the Butler Committee recommendations would involve very considerable expenditure. Whether we have got our priorities right within the total of available resources is, I would concede, an entirely different matter; but anything that might be added to expenditure on the subjects covered by the Butler Committee would only have to be met by savings elsewhere.
I think that I can say—and in this I hope I will get the assent of two former Chancellors of the Exchequer who are with us at the moment, including the noble Lord, Lord Butler, himself—that if we had not taken a particularly rigorous attitude on the question of public expenditure in the immediate past we would not now be in a position to begin to emerge from our period of economic difficulties. I take note of what the noble Lord has said in terms of priority for the future. I will make certain that that particular view, so vigorously expressed, is passed on to my right honourable friend the Home Secretary.
Second, I think that the House might find it helpful if I explained the manner in which the Butler Committee made its recommendations. There are, first, some recommendations of a pretty broad nature exhorting, in the words of Recommendation 126, "a massive injection of money" into certain fields of current central and local government activity. Then there are a number of recommendations for new administrative arrangements. The recommendation about the Advisory Board on Restricted Patients, on which I shall have something to say in a moment, is one obvious example. Then there are a large number of recommendations the implementation of which would clearly require legislation. These recommendations are, in turn, divided between those which would involve amendment of the Mental Health Act 1959 and those which could be implemented only in what would be, demonstrably, criminal justice legislation.
As for the very important recommendations for amending Part V of the Mental Health Act—the Part which deals with mentally disordered people who have committed criminal offences—I must say straight away that I shall not be in a position to announce any decision this evening. The reason for this is that, far from failing to react to the Butler Report, 1878 the Government have been actively reviewing the Mental Health Act as a whole. The Inter-Departmental Committee considering the matter published in August 1976 a consultative document setting out what were their provisional conclusions on the changes required in the Act and inviting views from interested bodies and individuals.
In the light of the response to the document—and I might say that the response has been substantial in quantity and closely argued in quality—the Government are now drawing up legislative proposals. We hope to publish them in the form of a White Paper before the summer. This is a point which was put to me. I do not think it would be right for me to seek to anticipate the proposals that the White Paper will contain.
Purely by way of illustration, however, let me say that the White Paper will contain the Government's proposals on the difficult question of whether, and, if so, in what circumstances, people suffering from psychopathic disorders should be compulsorily detained in hospital. This issue has been the cause of a great deal of concern in the debate. It will be dealt with in the White Paper which also will refer to the Butler Committee's recommendation for giving the courts new powers to remand mentally disordered people to hospital as an alternative to prison in circumstances where, for example, a medical report is required. On this we hope shortly to undertake a consultative exercise.
I should like to give another illustration of the conceptual and practical difficulties that the White Paper will attempt to resolve. This relates to the duration of restriction orders made under Section 65 of the Mental Health Act. The view of the Butler Committee was that the courts ought to be free to make restriction orders wherever they think this necessary in order to protect the public from serious harm and that, furthermore, all such orders should be without limitation of time. Since the report has been published, however, the National Association for Mental Health (MIND) has produced Volume 2 of A Human Condition, their special study of the law relating to mentally abnormal offenders. They take a different view from the one put forward by the Butler Committee.
1879 They propose that an unlimited restriction order should be available only in respect of offences which involve serious violence against persons or property, and that in all other cases the term of the restriction order should be proportional to the gravity of the current offence. I mention this matter now because it seems to me to exemplify the complexity of this issue and the high moral and political questions which are involved in this field.
I should like now to come on to a point raised by the noble Lord, Lord Winstanley, on an important aspect of the Butler Committee recommendations on which I can say that action has been taken in the light of the Committee's views. That is over the release of dangerous mentally disordered offenders from hospitals. As your Lordships have been reminded by the noble Lord, Lord Allen of Abbeydale, and others, it was the tragic case of Graham Young which provided the immediate occasion for the setting up of the Butler Committee. The Committee devoted a great deal of attention to the detailed procedure for obtaining the opinion of an independent advisory board on proposals for the discharge or transfer of restricted patients. This procedure was instituted in 1973 following the report of the Aavold Committee on the Review of Procedures for the Discharge and Supervision of Psychiatric Patients subject to Special Restrictions. It was limited to the fairly small number of restricted patients in the special hospitals whose cases had been previously identified as requiring "special care in assessment".
The House may recall that the Butler Committee recommended that all proposals for the discharge or transfer of restricted patients in the special hospitals should come within the purview of the advisory board and, in addition, that the board should continue to be concerned with former special-hospital-restricted patients subsequently as regards the grant of leave and their eventual discharge from local hospitals or secure units and throughout their period of supervision, including the question of recall, if it arose.
When the Butler Report was published, the then Home Secretary, Mr. Jenkins, welcomed the Committee's further guidance on this difficult problem and accepted 1880 in principle that there should be an extension of the present procedure. My right honourable friend the Home Secretary, while also accepting that some extension of the present procedure is clearly warranted, considers that the Committee's proposals if implemented as a whole would extend the functions of the present Advisory Board on Restricted Patients beyond the point that it is necessary or practicable to do so.
He has, therefore, decided to reject the Butler Committee proposals concerning the board with restricted patients subsequent to their discharge or transfer from a special hospital. As regards the Committee's central recommendation that all proposals for the discharge or transfer of restricted patients in the special hospitals should be referred to the board, my right honourable friend has now decided that it would not be right to accept this recommendation as it stands. He considers that the indiscriminate reference to an independent board of all special hospital cases, regardless of merits, would involve an unwarranted diminution of the responsibility of the doctors for the assessment of their patients. On the other hand, he certainly accepts that there are strong arguments for extending the range of cases in which he receives an independent opinion on proposals for discharge or transfer from the special hospitals.
In the light of these considerations, we have decided to introduce a revised procedure on the following lines. Under this procedure, which took effect on 1st March, it is assumed from the outset that all cases of restricted patients in the special hospitals require special care in assessment, such that they should be referred to the advisory board. But it is open to the responsible medical officer at any time to recommend to the Home Office that a case is sufficiently straightforward, having regard to factors such as the patient's diagnosis, response to treatment, prognosis and so on, not to merit reference to the board. Where such a recommendation is received by the Home Office, considerable weight is attached to it. But the Home Office reserve the right to refer to the board, whatever the clinical assessment, any cases where it is thought that the public interest requires this because of the seriousness of the particular offence or the notoriety of the offender. In cases of doubt, the bias of the Home 1881 Office will be in favour of reference to the board. Where the responsible medical officer is not prepared to submit a recommendation that a patient's case is too straightforward to require reference to the board, any proposal for the patient's discharge or transfer is automatically referred to the advisory board.
My right honourable friend is confident that this new procedure, as well as extending the range of cases coming before the advisory board, will be found by those who have to operate it to be more flexible and more straightforward than are the former arrangements.
§ Lord BUTLER of SAFFRON WALDEN
My Lords, before the noble Lord leaves that point, I think it is a serious statement that part of this recommendation is rejected. I am as keen as anybody else to look after the freedom of the subject, but we have been very worried at the decisions of some of the doctors. Is the noble Lord satisfied that this new procedure, which I shall be very interested to study and which seems to be very comprehensive, will be able to get round a bad decision by a local doctor?
§ Lord HARRIS of GREENWICH
My Lords, we have gone into this matter very carefully. As the noble Lord has rightly said, I have made a fairly complex statement on what is a most complex issue. We have gone into this matter with considerable care. We have come to the conclusion that the public interest will be adequately safeguarded by these arrangements; we certainly would not have contemplated them otherwise. If, after the noble Lord has had the opportunity of studying what I have said, he has any points, I will gladly look into any matter.
The Butler Committee also recommended that the Board should be involved in the recall of former special hospital patients. In my right honourable friend's view, mental health review tribunals are more suitable bodies to offer him advice on such matters than would be the Advisory Board on Restricted Patients. He therefore proposes, having consulted the council on tribunals and chairmen of mental health review tribunals, to promote an appropriate Amendment to the Mental Health Act 1959. The Amendment might take the form of a provision that on the 1882 recall of a restricted patient to hospital, his case should automatically be referred to a tribunal for advice on discharge.
In the light of this, it will not be necessary for us to reconstitute the present advisory board, as the Butler Committee recommended. I should like to take this opportunity of echoing Lord Butler's words to pay a warm tribute to the members of the board, and particularly to Sir Carl Aarvold, their chairman, for their careful and conscientious work, which will be added to by the new arrangements that I have just announced. My right honourable friend greatly values—as I am sure did his predecessors—their advice on these exceptionally difficult cases.
I should now like to turn to some other aspects of the report which has been mentioned by the noble Lords, Lord Allen of Abbeydale, and Lord Butler. These are the recommendations concerning persons who are under a disability in relation to trial, and those concerning the special verdict of not guilty by reason of insanity, which may be returned by the Crown Court. This is an extraordinarily difficult and complex area of the law, raising as it does the whole question of the circumstances in which mental abnormality should be accepted as excusing an offender from criminal responsibility. The sheer complexity of these issues led the Committee to devote no less than 34 separate recommendations and two chapters of their report to these subjects.
We have now completed our preliminary examination of all these recommendations. We shall be circulating consultative papers within the next few weeks setting out our provisional conclusions on them and asking interested bodies and individuals for their comments. I shall arrange for copies of these papers to be placed in the Library of the House. But I think it would be appropriate today if I were to give a broad outline of the provisional conclusions which will be embodied in the documents. I will try to be as brief as possible and to avoid technicalities, but I fear I will not be wholly successful. I shall start with disability.
The Butler Committee were not satisfied that the present law—which is contained in the Criminal Procedure (Insanity) Act 1964—provides a sufficient safeguard against the possibility that a defendant 1883 who is innocent of the offence charged, and thus entitled to an acquittal, may nevertheless because of his mental condition be unable to avoid a finding that he is unfit to plead and his committal to hospital. To meet such cases, the Butler Committee proposed that a new procedure should be introduced under which, where the defendant is found to be under disability, there would nevertheless be a trial of the facts to the fullest extent possible, having regard to the mental condition of the person concerned. The main object of the procedure would be to enable the jury to return a verdict of not guilty where the evidence was not sufficient for a conviction. The normal rules of evidence and burden of proof would apply. Where the jury were unable to acquit, they would return a verdict thatthe defendant should be dealt with as a person under disability".The Committee also suggested other improvements to the law. First, where disability has been found and there is on medical evidence a prospect of early recovery, the judge should have discretion to adjourn the trial for a maximum period of six months. Second, the court should have a discretion as to the disposal of persons ordered to be dealt with as under disability, with power to make a variety of social or medical orders ranging between a hospital order with restrictions and an absolute discharge, but with overtly penal sanctions excluded. And, third, magistrates' courts should be given equivalent powers to those of the Crown Court if dealing with persons under disability.
In general, the Committee's recommendations seem to us to be acceptable. The consultative paper on disability will thus welcome them in principle. The holding of a trial of the facts in every case, as the Committee proposed, would have the obvious advantage of providing as complete a safeguard as could be devised against the possibility of an innocent defendant being found under disability and committed indefinitely to hospital. But we do have certain reservations about the practicability and effectiveness of the detailed procedure recommended by the Butler Committee, one of which is that the procedure would lead to an acquittal in cases where the defendant did some act, possibly of a violent nature, 1884 but because of his mental state at the time it is not clear that criminal responsibility for an offence can properly be attributed to him.
As to the special verdict, the Committee considered that as a matter of principle the law should continue to provide for an exemption from criminal responsibility, and therefore from punishment, for offenders suffering at the time of the offence from mental disorder of an appropriate degree of severity. But they took the view that the present test for such exemption, the so-called M'Naghten rules, was unsatisfactory in that it is framed in archaic language, and too strictly, with the result that it can cover offenders to whom it is accepted that no criminal responsibility should attach only through being stretched. They considered that although the defence of insanity is nowadays rarely put forward, having for most practical purposes been superseded by the defence of diminished responsibility which was introduced by the Homicide Act 1957, there were sound reasons for retaining it.
They therefore devoted a great deal of time and practical ingenuity to devising a suitable replacement test. The formula they came up with is of considerable complexity, but basically there are two elements: a mens rea element, approximating to the first limb of the M'Naghten rules, and a specific exemption from conviction for defendants suffering at the time of the act or omission charged from severe mental illness or severe sub-normality. Other important proposals made by the Committee in this area of the law were that magistrates' courts should be allowed to return the special verdict of "not guilty by reason of insanity", and that, as in cases of disability, the courts should be given a measure of discretion as to disposal, with broadly the same powers to make a variety of social or medical orders ranging between a hospital order with restrictions and an absolute discharge.
The Committee's replacement test for the special verdict is considered in detail in the consultative paper we are circulating on this subject. The relevant passage, while seeking comments from practitioners, suggests that the test, although at first sight it appears to be rather complicated 1885 and difficult, would probably turn out to be workable in practice and capable of application in the magistrates' courts.
On the question of disposal of persons found under disability or not guilty by reason of insanity, we do see some difficulty. Under the present law, success in an insanity defence—and also a finding of disability—must result in the defendant's committal to hospital, where his status becomes that of a person made subject to a hospital order with a restriction order made without limit of time.
The justification of the present law is, quite bluntly, the protection of the public. The provision ensures that, for example, persons who have committed serious acts of violence but do not currently meet the criteria for hospital admission set out in the Mental Health Act, are not simply set at large, which they would otherwise have to be, as a prison sentence would not be available in such cases. However, under the Butler proposals the court would be able to send a defendant to hospital only if the usual requirement for making a hospital order had been satisfied. Thus, the court must have received evidence that the defendant is suffering from one of four categories of mental disorder named in the Mental Health Act of a nature or degree warranting his detention in hospital for a medical treatment and that there is a place for him in a particular hospital. If these requirements were not satisfied, under the Butler proposals the court would have no choice but to set the defendant at large.
The tentative conclusion which is put forward in the paper we shall be circulating on the special verdict is that there are strong arguments in favour of what the Butler Committee recommended, at least in so far as the medical reason for the making of a hospital order is concerned. But the Committee's recommendations would mean that, because the court would have no power to pass a sentence of imprisonment on such a defendant, they would be obliged to free even those whom the court considered dangerous, even if no hospital place had been found.
The paper therefore argues that this is in fact unacceptable and proposes that in cases of disability and of the special verdict, courts should have the power in the last resort to make hospital orders 1886 in the absence of evidence as to the availability of a hospital place, provided that they receive two medical recommendations in support of this proposed course of action. It would be left to the Home Office to give or to obtain a hospital place within the ensuing two months, as under the prevailing arrangements. So far as this particular view is concerned, we shall be interested to have the views of the Judiciary.
This debate has inevitably centred on a number of fairly detailed questions of the kind I have just been dealing with. My noble friend Lord Wells-Pestell spent a great deal of time on the point of secure units in his speech. I should just like to deal with one aspect of this matter concerning a question put to me at the outset of the debate by the noble Earl, Lord Mansfield, about the scale of the problem so far as prisons are concerned. I think we can state this problem very simply so far as secure units are concerned. If we do not get them, a large number of mentally ill people are going to remain in prison. It is quite unavoidable: no regional secure units—a large number of mentally ill people in prison.
The noble Earl, Lord Mansfield, mentioned a figure of 900. He is quite right: that figure appeared in the Press. I believe it appeared as a result of a fairly rough survey conducted by the Prison Department of the Home Office earlier last year. As so often happens, some necessary qualifications were omitted; for example, the figure of 900 included a number of prisoners who required psychiatric therapy but whose condition was not serious enough to warrant detention in hospital.
The Home Office is continuing to carry out surveys of mentally disordered patients, and I hope that as we go along these exercises will get progressively more refined. The last survey took place on 31st December last. It showed that on that day there were in our prisons 682 people whose mental condition, in the opinion of the prison medical authorities, warranted detention in hospital. Of the total, 216 were awaiting trial or sentence. Of the total number of sentenced prisoners, 201 were diagnosed as "mentally ill" as distinct from "suffering from mental handicap or psychiatric disorder".
1887 That is the scale of the problem, and I think those figures are as accurate as we are likely to get. It is a formidable problem because 680-odd people are kept in all manner of Prison Department establishments, from some of our dispersal prisons to local prisons; and some of the others in local prisons are fairly young teenagers, who are there because there is not enough secure accommodation of a different character in community homes.
It does not seem to me that there is anything particularly liberal about not having enough secure accommodation; in fact the very reverse is true. I remember taking part in a discussion some time ago when someone with greater knowledge than I said that I was devoting too much attention to the question of secure accommodation so far as children were concerned. I pointed out that the consequence of not having such accommodation was that those children went to prison. In exactly the same way, if we do not have enough of these regional secure units, prison is where these people will go, and we now have the situation that some of these children and some of these mentally disordered people are in the same prisons. That is a profoundly disturbing situation, which indicates very clearly the scale of the problem with which the Government are now confronted.
We have had an opportunity in this debate of dealing with some of the central issues which were raised in the report of the Butler Committee. They are, as the noble Lord, Lord Allen of Abbeydale, rightly said, of high importance: first, in dealing with some of our most grievously disadvantaged fellow citizens; and, secondly, in ensuring the safety of the general public. I think, again, that we are all indebted to the noble Lord, Lord Allen, for having initiated this debate.
§ 7.21 p.m.
§ Lord ALLEN of ABBEYDALE
My Lords, it has been extremely helpful, and in my experience, limited though it is, a little unusual, to have speeches from two Ministers in this debate. But I suppose that it is appropriate, when the Committee itself was set up by two Secretaries of State one of whom, I am glad to see, has now joined us on the Opposition Front Bench. I was very glad to have the assurances of 1888 the noble Lord, Lord Wells-Pestell, that the concept of regional secure units has not been ditched, and to listen to his extremely interesting discussion about the purposes of the units. I also listened carefully and with great interest to what the noble Lord, Lord Harris, has just been saying about the decisions which have been taken, and the promise of goodies to come.
It is a complicated and difficult subject and I shall not say any more, since I, like I think most noble Lords, should like to read with care the record of what has been said. My only further comment on the speech of the noble Lord, Lord Harris, is that I am afraid he was not quite accurate in suggesting that I had left the Home Office before the Butler Committee started to operate. In fact, I had the privilege of giving the inaugural evidence to the Committee and, not only that, the privilege of attending their inaugural lunch, at which pork pies were not on the menu. I am afraid that the standard must have deteriorated after I retired.
But it was a privilege, and for me quite a nostalgic one, to hear such a notable speech from the noble Lord, Lord Butler. I do not want to end on a critical note, but I have just one breath of criticism of what he said. He indicated that in my opening speech I had gone over pretty well the whole territory covered by the Committee's report. In fact, I can make no such claim, and I am extremely grateful for the various contributions which have been made in the speeches during the debate, on the areas on which I myself did not touch.
I shall make only two very quick points on the speeches which have been made. First, the noble Lord, Lord Winstanley, was, in a measure, critical of the drafting of the Motion, and he read the words,To call attention to the outstanding recommendations made in the reports",as implying that a lot had been implemented. It was not drafted with any such intention. It was just drafted with my normal kindliness, in acknowledgement of the fact that something, at any rate, had been done.
Then there were two points made by the noble Earl, Lord Longford, and the noble Lady, Lady Kinloss, which really illustrated the whole problem that we are talking about. The friends of the noble 1889 Earl, the shop stewards, said that they wanted no part of violent patients who had to be treated in conditions of security, but, unfortunately, the problem will not go away. I said in my opening that it is always very comforting to think that someone else will cope, and this is what the shop stewards were doing. But someone has to find a solution.
Then the noble Lady, Lady Kinloss, in her very interesting speech, suggested that the Home Secretary was perhaps not paying sufficient attention to the wise guidance of the doctors who knew these patients so well. But I am bound to say, without being in any sense critical, that it was on medical advice that Graham Young was released, which is what started it all off. I have one other comment on the speeches. Perhaps I could get together with the noble Lord, Lord Butler, after the debate and give him some guidance about the backdoor to the Elephant and Castle, which I happen to know rather more about than the backdoor to the new Home Office in Queen Anne's Gate.
We have had a debate which has cut right across Party lines. It has elicited most interesting statements about the approach of Her Majesty's Government. We shall not inquire too closely into what has been happening between 1975 and the statements made today. But if, in addition, the debate has done anything to enlighten public opinion, and to emphasise not only the complexity but also the urgency of these problems, it will have served its modest purpose. My Lords, I beg to withdraw my Motion.
§ Lord BUTLER of SAFFRON WALDEN
My Lords, may I ask the noble Lord, Lord Harris, whether, besides his very able speech, there will be any White Paper, or shall we just rely on Hansard?
§ Lord HARRIS of GREENWICH
My Lords, I indicated earlier that there would be a White Paper on one area. I also indicated that we should be putting some papers, on a different but related matter, in the Library of the House. But I have given some fairly clear indication of the territory which these papers will cover.
§ Motion for Papers, by leave, withdrawn