Prisoners: Mental Treatment (Hansard, 18 February 1982)

§ Baroness Faithfull
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Elton)
My Lords, we do already have over 2,000 mentally disordered people in our hospitals who have come there either from prison or direct from the courts. It may be that the empty wards into which my noble friend wants us to put other prisoners are in large mental hospitals which are being replaced by smaller units. These closures are in line with the agreed policy of humanising the scale of institutions for long-term residential care. If so, the wards are empty by design and the resources needed to staff and service them have been moved elsewhere. The empty accommodation on its own will not be of any use.

§ Baroness Faithfull
My Lords, I thank my noble friend the Minister for that reply. I appreciate that there are questions of staffing, but may I ask him whether it might be wise for a survey to be carried out, bearing in mind that in 1971 there were 132,000 patients in hospitals for the mentally ill and that there was a drop to 103,000 leaving 29,000 vacancies. Would it not be possible, despite the probelms of staffing, to place the 229 mentally ill patients at present in prisons in these hospitals? Secondly, may I ask my noble friend what is happening about the mental hospitals that are closed and standing empty? Could they not be used for relieving the pressure in the prisons both for the mentally ill and for others?

§ Lord Elton
My Lords, on the question of the numbers of prisoners in the category to which my noble friend refers, at 30th September last there were 170 convicted inmates considered to be suffering from a mental disorder who could be detained under the 1959 Act. Mentally disordered offenders are just like other people with mental disorders; some of them need to go to hospital for treatment and others do not. The Act distinguishes between the two categories.
What we cannot undertake to do is to send a mentally disordered person to hospital simply because he has committed an offence when he would not have gone 644 to hospital if he had not committed an offence. As to the empty hospitals to which my noble friend refers, we are aware that it is proper to consider the use of such accommodation and we do so in consultation, among others, with the Home Office, but the difficulties of bringing them into different use are often more considerable then perhaps might be expected.

Lord Winstanley
My Lords, while fully accepting some of the points made by the Minister in his earlier replies, may I ask him whether he agrees that it would be extremely unwise to start reducing the capacity of our mental hospitals, or to start disposing of allegedly superfluous accommodation, until we have accurately quantified the real need, which must include the numbers of people referred to by the noble Baroness who are perhaps in prison who ought really to be in mental hospitals?

§ Lord Elton
My Lords, I take the noble Lord's point absolutely. I have tried to show that the number of people we can address ourselves to in this context is only 170, because unless people qualify under the 1959 Act it is not in the power of either the Department of Health and Social Security or the National Health Service to detain them anywhere. As regards the empty accommodation, of course we always do consider very carefully what should he done with it. It is the product of a policy which is generally welcomed of establishing smaller units in place of larger ones.

Lord Inglewood
My Lords, may I ask my noble friend whether there are many prison hospitals in this country which have the facilities to give worthwhile treatment to mentally disordered offenders?

§ Lord Elton
My Lords, the prison service has health provision within it. I cannot answer as to specific and individual institutions, but I am not aware that patients are denied treatment when they need it simply because they arc in prison. Indeed, I have tried to point out that, just like people outside prison, if they do not need to go to a hospital they receive treatment in the normal way.

§ Lord Avebury
My Lords, would the noble Lord consider the difficulties that sometimes arise on the boundary where the prison psychiatric service considers that a person needs to be treated in a hospital but the hospital, when they examine him, believe that he is perfectly all right? This happened in the case of Richard Campbell who, the noble Lord may remember, was thought to be suffering from schizophrenia when he was in prison, but when he was sent to St. Bernard's, Southall, they found that he was perfectly normal and he was sent back to prison where he subsequently died of dehydration. Does not the noble Lord think that this tragic and unnecessary death indicates a failure of communication between the prison medical service and the psychiatric hospitals which needs to be examined, perhaps in the case of patients such as Richard Campbell, who was a Rastafarian, by Sir George Young who has just been appointed particularly to look into questions of race? 645 I know that that is in the Department of the Environment, but perhaps he could look into these as well.

§ Lord Elton
My Lords, I do not want to pick up a particular case, but the generality of the noble Lord's references are to occasions when there is a difference of professional medical opinion between people in two different establishments. When that happens it is necessary to consider carefully the individual case under consideration. I do not think I can go further than to say that these cases always are difficult, and that I do myself pay close attention to them when they are brought to my notice, but one can never ensure that medical opinions will coincide. It is not the case—as might be inferred from the noble Lord's question— that the difference of opinion always lies between medical practitioners who operate in different institutions.

§ The Earl of Lauderdale
My Lords, would my noble friend not agree that the rather general nature of his original reply does surely argue for his being somewhat forthcoming to the noble Baroness's request in her supplementary for a survey? Does not that point still arise?

§ Lord Elton
My Lords, as I understand it, the noble Baroness wishes us to be certain that the extent of accommodation is at least equal to the extent of need. That is a principal object of the department's policy throughout and does not call for a specific survey.

§ Lord Molloy
My Lords, while broadly in agreement with what the noble Lord has said, may I ask whether the noble Lord would agree that, should changes of this kind be contemplated, the legal status of the staff involved would also have to be considered?

§ Lord Elton
My Lords, while I am not absolutely clear on what the noble Lord is aiming at, he will be aware that the legal status of staff in mental institutions is one of the matters to which we have directed the effects of the Mental Health (Amendment) Bill at present before your Lordships' House.

Lord Wallace of Coslany
My Lords, is the noble Lord aware that the hospitals which are mainly the subject of closure are in fact, and no doubt he will agree with me, ancient monuments that only need to be demolished?

§ Lord Elton
My Lords, that is very often the case.