§ 8 p.m.
§ The Earl of Longford rose to ask Her Majesty's Government what steps they are taking to respond to the statement of the Chief Inspector of Prisons that many mentally ill offenders are at present inappropriately confined to prison.
§ The noble Earl said: My Lords, I rise with a sense of gratitude to the noble Lords who have not deserted the sinking ship at this stage of the proceedings—I want to give plenty of opportunity to my noble friends Lord Hatch and Lord Kaldor to decide whether they want to stay to listen to me or to go elsewhere; I take no offence. My Lords I rise to ask the Unstarred Question standing in my name. I must say that I must strike a highly critical note this evening which I hope will be attended to by noble Lords opposite even more widely than appears likely at the moment. No Conservative Peers are sitting anywhere except on the Front Bench, but that we understand. I feel sure that the esteemed Minister who is going to reply will agree with me on one point at least: that this is a very difficult subject. The difficulties are intrinsic in theory and still more in practice. We punish law breakers; we do not punish sick people—we try to heal them. But the mental offenders with whom we are concerned this evening fall on both sides of the line. We search in vain for the perfect way to deal with them. The problem will never go away but we could cope with it far better than we are coping at present.
§ We—and I am speaking of the community as a whole, but the Government have a special responsibility because they are in charge of our affairs—are failing, as I see it, in a double duty. We have the duty to try to clear our minds about the ethical and psychological issues and we have the duty to make far more adequate provision in practice for administrative actions. I submit that the first failure, the failure to make up our minds as to what we ought to be doing, is, to a considerable extent, responsible for the second, the failure to deal with these human beings in a manner beneficial to them and to society.
It would be helpful to read the paragraph in a recent report by Her Majesty's Chief Inspector of Prisons from which my question is extracted. Chapter 2, paragraph 19 of that report goes like this—and now I am quoting:
In previous reports we have expressed our concern about the detention of mentally disordered offenders in prison, when what they need is treatment in an appropriate psychiatric institution. Prison medical officers have frequently told us that managing mentally ill offenders was the hardest part of their duties. Many Governors expressed similar views. There may be room for argument over the number of those offenders who would be better cared for in a mental hospital, but there can be no doubt that many are inappropriately confined to prison".
That means, in the context, many mentally-ill offenders.
§ This would appear to represent a very disquieting situation. But it appears that the Government view it with the utmost complacency. The official view is equally bland, whether delivered through the mouth of the noble Lord, Lord Glenarthur, speaking for the DHSS. or through the mouth of the noble Lord, Lord Elton, speaking on behalf of the Home Office. I 352 suppose that somehow it is satisfactory that the Government should speak in the same tones whoever the Minister, but it can also be disconcerting.
§ The subject is, in a sense, a hybrid. What appears to be necessary is a transfer of a considerable number of prisoners from the department of Lord Elton to the department of Lord Glenarthur. It is in just these situations (as I think everyone with experience knows) where the responsibility falls between two stools that failure is most likely; and, it would seem, complacency; because no Minister and no department likes to feel that his department or their department is to blame.
The noble Lord, Lord Broxbourne, who, I believe, cannot be here tonight, put down on 28th November last this Question:
To ask Her Majesty's Government whether they are satisfied that the courts are in a position to give effect to their power to order hospital admission or guardianship in appropriate cases in accordance with Section 37 of the Mental Health Act 1983".—[Official Report, 28/11/84: col. 897.]
The noble Lord, Lord Glenarthur replied—and I sent word, which I hope reached him, that I was going to mention him in this connection—
Yes, my Lords, we are generally satisfied".
But the House were generally dissatisfied. In fact, they were totally dissatisfied, as anyone will discover who follows the exchanges in Hansard.
The noble Lord. Lord Glenarthur, replied to a supplementary question from Lord Ennals in this way:
I hope that he [Lord Ennals] will be pleased to hear that there has been continuing progress in the programme of regional secure units, and the present position is that seven permanent secure regional units are now open. which will eventually provide a total of 264 places of which about 120 are now staffed and available".
I will repeat that last phrase: "about 120 places are staffed and available". I am sure that the noble Lord, Lord Glenarthur, who is highly intelligent, had his tongue in his cheek when he expected us to be pleased about the progress, or the lack of it, that he was announcing—264 places. of which 120 are now staffed and available. We are not told how many of these 120 places which are now staffed and available are actually occupied and how many of those are occupied by offenders, with whom our concern is this evening.
§ When I myself investigated these matters on the ground in connection with a debate that I initiated in July. I became aware that that question was a very pertinent one—how many offenders were there (in any total recorded) who were occupying these places? I have given notice of that question to the noble Lord, Lord Elton, today—not very much notice, some hours' notice—but, taking the figures even at their best, there was no room for complacency or even satisfaction. As was brought out in the debate which I initiated in July of this year, the Butler Report on Abnormal Offenders, with which the noble Lord, Lord Allen, was so much connected (which I think we can attribute to his inspiration when he was head of the Home Office), recommended ten years ago that 2,000 places should be available. Let us keep some sort of track of the figures: 2,000 places recommended ten years ago and now 120 available, some of them not for offenders.
I believe the Government accepted in principle the report—the noble Lord, Lord Allen, will speak more
authoritatively—although I am not sure that they accepted that particular figure of 2,000 places. At any rate, the record of the Government to date recalls to me a remark of the late Lord Beveridge when he was asked by the Secretary of State for War in about 1942 what he thought of the Government's arrangements for making use of skilled manpower in the Services. I should explain that Lord Beveridge had been invited to investigate this issue, with myself holding his coat tails. He replied, to the surprise of the Secretary of State for War, who was surrounded by generals:
A miserable show, a miserable show".
I can think of no better words to describe the record of Governments in the last 10 years with regard to regional secure units.
The noble Lord, Lord Elton, meanwhile has already given a Written Answer closely related to the Unstarred Question we are discussing this evening. In a reply dated 27th November, he informs me—and I quote—
The Government are making headway in transferring to hospital sentenced: prisoners who are mentally disordered within the terms of the Mental Health Act 1983. The latest statistical return shows that on 30th September the number of such prisoners held in Prison Department establishments fell below 100 for the first time since recording began in 1977".
So the noble Lord, Lord Elton, was able to supply what he thinks is an encouraging figure: there are fewer than 100 people at present who could be transferred from prison to hospital within the terms of the Mental Health Act 1983.
§ Here we seem to be talking about two different things. The Chief Inspector records his opinion that there are many—I repeat "many"—mentally ill offenders who are inappropriately confined to prison. The noble Lord, Lord Elton, informs us that the number of prisoners who are mentally disordered within the terms of the Mental Health Act 1983 has fallen below 100 for the first time since recording began in 1977.
§ One reaction to this—it may or may not be the reaction of the noble Lord, Lord Avebury, but we shall hear from him later—with which I shall sympathise, is to say, "So much the worse for the Mental Health Act 1983". There are many mentally ill offenders who are not mentally disordered within the terms of the Mental Health Act, and therefore that Act ought to be drastically revised. I hope that one day it will be, and the sooner the better. The House may care to look at a major article in the Guardian today, describing the great inadequacy of the Mental Health Act in relation to mental offenders.
The whole of our law relating to mental offenders needs, I would submit, thorough revision. Meanwhile we are bound to ask: Are the Government doing all they can to cope with the situation while the law remains as it is? I cannot persuade myself that they are. The noble Lord, Lord Elton, assured me in a Written Answer, to use his words, that
for prisoners who cannot be transferred under the Mental Health Act we are planning to extend the range of psychiatric facilities, for example, by reopening the therapeutic unit formerly housed at Parkhurst".
§ Here I must put a question of which, again, he has had some hours' notice. How far would it be true to say that the psychiatric facilities now available in 354 prisons are at the moment inferior to those which existed a few years ago? From what the noble Lord has said, that was obviously the case in Parkhurst. It is certainly, in my experience, the case in the hospital wing at Wormwood Scrubbs, but I am not pronouncing on the whole range of prisons. The noble Lord may wish to say a word about the extent of the provision of psychiatric facilities in our prisons at the present time and how it compares. It would be a pretty wretched story if it is not better, in view of the great increase in the number of mentally ill people over what it was some time ago.
§ The noble Lord, Lord Donaldson, who cannot be with us tonight, is our great expert on Grendon. I will leave Grendon for him to speak about on another occasion but I will at least ask this, and I know that he will sympathise with this question: Why have we never built a second Grendon? Perhaps the noble Lord, Lord Elton, will answer that also.
§ Lord Elton
My Lords, I am so sorry: perhaps we may be able to do what to Grendon? Unfortuntely I missed the word.
§ The Earl of Longford
My Lords, it is a very simple question: Why do we not build a second Grendon? It is good news if the Government intend to improve the psychiatric facilities in prison, but I am afraid that I and many others will reserve judgment until we see these new facilities in operation.
At this point—and I draw towards a close but I am not quite finishing yet—I must return to an illustration that I have used before in this House. I visited a prisoner for 15 years; I visited him every month during the last year. He has been in prison altogether for 19 years. About 13 years ago—this is a good illustration of a certain aspect of the problem—the late Dr. Peter Scott examined this prisoner very carefully on behalf of the Home Office. The late Reginald Maudling, the then Home Secretary, tried to secure the transfer of this prisoner to Broadmoor. I remember very well visiting this prisoner in Durham when this departmental wrangle was proceeding. He was left almost alone there—not quite alone, because there is some rule apparently that you cannot leave one prisoner alone in a wing, so they left another prisoner there just to keep him company and to keep up apearances. At any rate there were just the two of them there while this wrangle went on. The whole top security wing at Durham had been vacated, except for this prisoner and one other.
Eventually the Minister of Health, Sir Keith Joseph—he was, I think, a tougher character in those days—prevailed, and the man remained in prison instead of going to hospital, in spite of the Home Office view that he should go to hospital. Many years later this prisoner was again investigated, and still more thoroughly, by a Home Office psychiatrist, who recommended once more that the man should go to a special hospital. I have been allowed to see a copy of that report. However, nothing happened, and he remains in prison.
No one can doubt that this man is ill. Although he has no organic disease, I am told that his weight has come down from 13 stones to eight. An eminent man who visited him for several years in Wormwood 355 Scrubbs recently visited him in his present prison and could not believe that he was the same man; so no human being, seeing him, could say that this man was anything but ill, and it is very difficult to say that he is anything but mentally ill. I am told that the Home Office are having difficulty in finding a second psychiatrist who will support the view of two of their own psychiatrists over the years who have recommended that he should go to a special hospital. I had some sharp words prepared this evening to aim at the noble Lord, Lord Elton, but while I was getting ready to speak the noble Lord was kind enough to inform me that another psychiatrist—I know him personally, for what that is worth, and I have complete confidence there—is now going to see this man again.
I do not want to disturb matters. I shall cross my fingers, offer up prayers and say, "Better late than never". But I give this case as an example, if you like, of one of the difficulties in dealing with a case of this kind or, you may say, of the very tepid efforts made by the noble Lord's Department to deal with this particular case. But now they are turning over a new leaf. This is the first time I have ever been able to congratulate the Home Office in all the years I have been dealing with the noble Lord, Lord Elton. I cannot remember another occasion; so let us be thankful for small mercies.
I pose again to Her Majesty's Government the question which I asked in the debate on the Address. It was ignored by the Lord Chancellor when he replied, and the noble Lord the Minister has so far not answered it. I put to the noble Lord the question which I put to him recently. Do the Government accept the opinion of the Chief Inspector that,many mentally ill offenders are at present inappropriately confined to prison"?Do they accept that or not? Is the answer, "yes", "no", or "don't know"? I should be very grateful to get their answer. If that claim is accepted, would they agree that it covers a much larger number of prisoners than the fewer than a hundred who are said to be mentally disordered within the terms of the Mental Health Act 1983? If so, what steps are the Government taking to deal with this evident scandal?
§ 8.21 p.m.
§ Lord Avebury
My Lords, I am sure we all admire the determination with which the noble Earl, Lord Longford, pursues these matters, and I am grateful to him for the opportunity that it gives us for discussing the state of a small but important number of prisoners confined, inappropriately, as the Chief Inspector puts it, within the prison system and, if I may venture to broaden the debate somewhat, not only the prisoners with whom the noble Earl, Lord Longford, is primarily concerned, but that other group which is mentioned by the Chief Inspector lower down in the same paragraph where he refers to the:Mentally disturbed offenders who cannot be admitted to mental hospitals and for whom alternative treatment regimes need to be provided.As the noble Earl, Lord Longford mentioned in passing, what happened with the Mental Health Act 1983 was that the wording of the old Section 72 of the Mental Health Act 1959 was altered so as to make it 356 more difficult to transfer prisoners from the prison system into the special hospitals. You will recall, my Lords, that the requirement now is that, if a person is suffering from a psychopathic disorder or mental impairment, the treatment he will receive in the special hospital has to be shown as,Likely to alleviate or prevent a deterioration of his condition".That is a test more difficult to satisfy than the one in Section 72 of the old Act, where the Secretary of State had to consider only whether the mental disorder from which the prisoner was suffering was such as to make it,expedient to make a transfer direction".In other words, the Secretary of State had complete discretion to decide whether or not to transfer the prisoner, irrespective of the likelihood that treatment was going to benefit him in his illness.
The result of this change is that a prisoner who is labelled as untreatable at the time of his conviction is likely to remain permanently within the prison system, as I ventured to predict when your Lordships had the question of transfers under consideration during the proceedings on the Mental Health Act (Amendment) Bill in February 1982, and I believe that this is in fact happening.
As far as I am aware—the noble Earl, Lord Longford, seemed to have some figures which suggested otherwise—there was no attempt to distinguish between those eligible for transfers but for whom places cannot yet be found, and those whose untreatability means that, in spite of the mental disorder which afflicts them, they are likely to remain permanently within the prison system.
We are given periodically the total of mentally disordered persons and a breakdown into sentenced and unsentenced. The number did come down—one has to congratulate the Home Office and the Department of Health and Social Security on this —from 769 at the end of June 1977 to 286 at the end of September 1982, although in the next six months after that it rose again to 319. I do not know whether the noble Lord the Minister will remember this but he wrote to me in July 1983 expressing the opinion that this was the sort of fluctuation that one might have to expect, adding that he would be looking at the next set of figures with great care to ensure that the long-term trend had been resumed. I rather gathered from what the noble Earl, Lord Longford, was saying about the number having declined to only 100—I think that was the figure he gave—that great progress has been made in the past 18 months. But I wonder whether the noble Lord, Lord Elton, can give us some figures for September 1983 and March 1984 and perhaps even for September 1984, if the figures which the noble Earl, Lord Longford, was quoting came from the Home Office. Is it possible to give an estimate of the number of persons suffering from mental disorders who are likely to remain within the prison system, when all those who are eligible for transfer under Section 47 have been moved?
According to the working party which was chaired by Monsignor Atherton, the Deputy Prison Chaplin, on Regimes for Dangerously Disruptive Prisoners, only 10 to 15 inmates came within its definition of "dangerously disruptive"—that is to say: 357one who, having murdered or committed some other grave assault against the person, shows by his serious anti-social conduct such as hostage-taking, that he constitutes a continuing though unpredictable threat to the prison community".These people are by definition suffering from a psychopathic disorder, which is described in the Mental Health Act as:abnormally aggressive or seriously irresponsible conduct".There may be others, whose disorder is not quite so serious, but who nevertheless present very severe problems of management over periods of many years within the prison system. This will depend to some extent on the way in which society expects the parole system to approach the question of risk. As the Home Office points out in its Research Unit Study No. 64, Taking Offenders Out of Circulation:Because crimes of violence are comparatively rare, attempts at prediction will therefore produce large numbers of what are called false positives—people who fail to conform to expectations which are derived from observations of only a few of them.In other words, if the policy is to play absolutely safe, then we keep in custody for the whole of their natural lives everybody who has been guilty of certain types of violent offence, on the basis that by doing so, we are going to reduce the incidence of future offences of that kind. But at the same time, according to the Home Office study, we would be keeping behind bars large numbers of offenders who would not have repeated their crimes if they had been released.
The notion of incapacitation is also in conflict with the idea that has been gaining ground over the past few years of a tariff which, when applied to an indeterminate sentence, allows the prisoner to work positively towards a long-term release date. Where psychiatrists reach the conclusion that a man should be held in custody beyond the term which is required for punishment, as has been indicated by the tariff, they should be obliged to justify their decision before some kind of independent tribunal constituted for that purpose, as they would have to do if the patient was in a special hospital. I should like the opinion of the Minister on this—perhaps not this evening but when he has had the chance to think about it. When a prisoner is detained beyond the end of a tariff period and that decision has been taken wholly or mainly on the basis of psychiatric advice, there should then be a right of access to the Mental Health Review Tribunal, as there would be in the case of a person who is detained for a similar period in a special hospital.
I should like to mention in this connection the case of Mr. A. G. D., who is the longest serving prisoner in our system. He was convicted by a field court-martial in Italy in 1944 of the murder of a nine year-old girl, and was sentenced to death. The death sentence was commuted, and in December 1949, after only five years in prison, the then Home Secretary released Mr. D. on licence. But then five years later, in December 1954, he pleaded guilty to indecently assaulting an eleven year-old child, and was, sentenced to six months' imprisonment. The then Home Secretary revoked his licence, since when he has spent the next 30 years uninterruptedly in prison. Mr. D. had not been seen by a psychiatrist from outside the prison system (as distinct from the prison medical officer who was psychiatrically qualified) since 1976 until this year, when, following some correspondence I had with Mr. David Mellor in the Home Office, the prisoner 358 was seen by Dr. Faulk of the Knowle Hospital, Fareham.
As is usual on these cases, the doctor's report was not made available to Mr. D. or to any of his advisers. If he is still considered to be dangerous, 30 years after committing the offence of indecent assault for which the court thought an appropriate sentence was six months, first of all he and his advisers will never know the reasons for that opinion, but, more important, they are not going to have a chance of contesting them. I think that when society decrees that a man should spend as long as that locked up behind bars—a 72 year old man who committed an offence 30 years ago—he has a right to a hearing before some kind of objective tribunal.
§ The Earl of Longford
My Lords, I did not know about that appalling story. Before the Home Office committee under the chairman of the Parole Board was abolished, would he not have had the opportunity of being considered by that committee?
§ Lord Avebury
My Lords, the point made by the Home Office when one approaches them about this matter is that the Parole Board have never recommended that this man should be considered for release so it must be presumed that, on the basis of the evidence before it, he could still be a potential threat to the public if released. My point is that nobody knows on what basis the parole authorities reach that decision. Even the Home Office do not know because it did not have to entertain a recommendation by the parole authorities.
The general attitude of the Home Office is exemplified by a letter which I received from Mr. David Mellor in August. He concluded that if the Home Secretary was ever called upon to decide whether to accept a recommendation for Mr. D's release he would have no hesitation in resolving any doubt there might be about the degree of risk involved in favour of the general public. In other words, even before anyone suggested to him that Mr. D should be released he was already in the frame of mind to turn down such a suggestion. A similar line could perhaps be taken by psychiatrists because, after all, no one ever criticises these people for keeping prisoners behind bars, but there would be an outcry from the gutter press if, following a recommendation by a psychiatrist, the released person committed a similar offence again.
The next point I want to make concerns the report of the working party under Monseigneur Atherton which recommended a special unit for the small number of prisoners with whom it was concerned, but one very different in its regime from the notorious special unit which the Home Office tried to establish clandestinely a few years ago. One of the features of the proposal from Monseigneur Atherton and his committee was the permeability of the unit's boundaries with the prison system generally; and this is in conformity with two ideas emphasised by the Control Review Committee in its report Managing the Long-Term Prison System. It referred to the need to avoid creating last-resort situations from which prisoners may see no way out, and they underlined the need for sentence planning. It is essential, in my view, that prisoners who present serious control problemsx—of whom the Control Review Committee estimate there may be 150 to 200—should be able to graduate, as it were, from whatever special accommo 359 dation is provided for them back to the wing on the satisfaction of an objective test which has been explained carefully to them, so that they can see what they have to do to comply with it.
The Control Review Committee referred in particular to the high security cells at Wakefield which provide a better quality environment for prisoners considered to be exceptionally dangerous than could be offered in a segregation unit. They do; although the amount of contact with one other human being which they provide is extremely limited and the committee rightly say that it is important to ensure that such prisoners spend no longer in these cells than is absolutely necessary.
The Minister is familiar with the case of Mr. RJM who has been segregated continuously since July 1978, latterly in the special cells at Wakefield. The logic of the argument of both Monseigneur Atherton's committee and the Control Unit Committee is that he ought to be given some idea of the conditions that he has to fulfil before he can move towards association with other prisoners. The implication of paragraph 64 of the Control Unit Report is that until there is a network of long-term units, beginning with the five or six which presumably—although they do not make this clear—take an average of 30 prisoners each, the two individuals in the special cells at Wakefield must expect to stay where they are. If that is the policy the prison authorities should say so and enable the men concerned to do their best to adjust to the idea of another several years in the special cells. On the other hand, I hope it will be possible to give these people some idea of exactly what conditions they must fulfil before they can begin to move back to normal association with other human beings.
The only other prospect for prisoners like Mr. M would seem to be—and the noble Earl, Lord Longford, mentioned this in passing—the idea of broadening Grendon's therapeutic regime. on which I understand advice is being sought from a committee chaired by the Director of the Prison Medical Service. It is said that as a result of this work Grendon may be able to accept in future highly difficult and disruptive prisoners. It would be good to hear something from the Minister, if he is able to say anything on the matter, about the progress of the chief medical officer's work.
The description of Grendon as a therapeutic environment seems paradoxical, because the inmates who go there must have been assessed as unlikely to have their mental disorders alleviated by treatment or they would have been transferred under Section 47. Perhaps the group psychotherapy practice at Grendon is not available in the special hospitals; or perhaps there are patients whose treatability is a matter of uncertainty and a greater variety of experimental treatment regimes could be provided within the prison system for those who do not qualify under Section 47 but who may. nevertheless, be thought worth an attempt at treatment, however unlikely the chance of success.
For example, what is to be done with a prisoner like Mr. JSB who was originally made the subject of a hospital order under Sections 60 and 65 of the 1959 Act in June 1981, and then, after the medical evidence was found to have been flawed in some way, brought 360 back to court and given a life sentence—the judge expressly saying that it was in order to see that the accused was given the treatment he needed? This man writes to me saying that he has petitioned the Secretary of State four times without receiving an answer. I am afraid that the Home Office, in spite of the instruction given by the Minister, is still not meticulous in replying promptly and fully to petitions, as it ought to be on matters that are of the utmost importance to the people concerned.
To take another case, that of Mr. DJL, who has recently been examined with a view to his transfer to Park Lane Hospital but has been told that because there is no place for him there at the moment he has to return to the wing for the time being. We need some halfway house between the special hospitals, on the one hand, to which a man can be sent only if he satisfies the conditions of Section 47. and the normal accommodation on the wing which is unsuitable for people suffering from mental disorder. The Minister may recall that in a paper entitled A Good and Useful Life by Mr. Harry Gruner of my office, published in 1982. it was recommended that two specialised wings should be designated at the existing dispersal prisons on the lines of the former C Wing at Parkhurst. I think it was the predecessor of the noble Lord with whom I discussed this matter—the noble Lord, Lord Belstead—who at that time was very interested in examining thoroughly the provisions of Rule 43 and, in particular. the way in which Rule 43 was applied to violent and dangerous prisoners.
The Control Unit Committee make a similar recommendation. It says that in C Wing there was never any suggestion of bringing about a lasting improvement in prisoners' behaviour but rather of providing another way of managing disturbed and difficult prisoners without having to segregate them. But perhaps a reconstituted C Wing could take on the job of assessing suitability of the prisoners concerned for transfer to Grendon and of holding patients pending their transfer to Broadmoor or Park Lane.
At their best the special hospitals offer a quality of life which is immeasurably superior to that of the prisons, and I believe that, with imagination and a good degree of openness to ideas from outside the system, the long-term units suggested by the Control Review Committee could provide a far better environment for the 150 to 200 prisoners than they could ever hope to enjoy in the present fabric. The problem will be to create those units physically within category B training prisons and local prisons where there is no room, rather than in the dispersal system where it might just be managed.
My fear is that because of the planning and capital expenditure implications of these proposals, nothing will come of them for many years. But I hope that Ministers will not allow this to happen, because the solution of the problem of regimes for this small group would have beneficial results for the individual prisoners and would improve the manageability of the dispersal system as a whole.
§ 8.40 p.m.
§ Lord Allen of Abbeydale
My Lords, the noble Earl is indeed to be congratulated on raising this topic. It is an aspect of a subject that we have discussed on more 361 than one occasion. I must say that I hope that we shall keep on discussing it until we get reassurances rather more satisfactory than any that we have received so far. I considered it right to put my name down to speak in this debate since I thought the voice of a Cross-Bencher, however inadequate, would demonstrate that this is an issue cutting across any party lines, although looking at the Benches opposite I note that the Conservative Party has been careful not to make too ostentatious a display of its deep concern with this very difficult human problem.
Until I heard the noble Lord, Lord Avebury, I was just a little surprised that it fell to the noble Lord, Lord Elton, to answer this debate. I suppose that when business was being arranged the two facts that the Motion actually referred to prisons and that it is a very awkward topic for the Government to handle pointed to entrusting the responsibility to the safe hands of a Home Office Minister. But the main questions that I shall be raising, and those that the noble Earl raised, primarily affect the DHSS. The Home Office for its part must he only too anxious to free itself as far as possible of an element of the prison population which is totally unsuited to prison conditions and must make a disproportionate demand on prison resources.
I have been re-reading the report of the May Committee of Inquiry into the Prison Services, and I am reminded that, putting it crudely, that committee said that it was not a bit satisfied that the DHSS people really appreciated the gravity of the problem. The committee said that it was left with the impression that the DHSS representatives were more concerned with the convenience of not disturbing the structure of the NHS in the interests of a small minority and of avoiding local trouble than with ensuring that the NHS carried out its functions effectively in that context.
Looking back at the various debates that we have had about alternatives to prison custody in that context, one of the themes which has kept on emerging is that there would be really no worthwhile progress without the full interest and co-operation of the psychiatric consultants themselves. It was not crystal clear that those were forthcoming. In both respects progress depends on a change of attitude. My first question therefore is whether there is reason to suppose that in the last year or two there has indeed been a change of attitude among both those concerned with organising the NHS and the psychiatric consultants. I hope that there has been, because without such a change we shall not get very far.
My next question inevitably relates to the progress—if that is the right word—of the semi-secure units to which the noble Earl has already referred. We have indeed been talking about this story for years and years under Governments of both complexions, and a pretty sorry story it is. Going back to the May Committee again. it was told by the DHSS that the plan was to complete the provision of 1,000 places by 1985–1985, just a few weeks away. The committee was profoundly sceptical, and rightly so. As the noble Earl has just reminded us, the noble Lord, Lord Glenarthur, was telling us the other day that there are now about 120 places available—120 a decade after the acceptance of the Butler recommendation by the Government of the day. Further, he said that it was 362 hoped to have 650 places by the end of 1987. As every forecast which has been made so far has turned out to be wrong, one is bound to be dubious about that estimate. But even if it is met, it is still a long way short of the initial programme of 1,000 places. I wonder what the Minister will be able to say for our greater comfort this evening.
In spite of our various debates, very little has been said so far to enlighten us about the criteria for admission to those units and about whether there is indeed any national policy or whether it is simply left to the personal judgment of the individual in charge of the unit, without any guidelines from the centre. I hope that the noble Lord the Minister will this evening be able to tell us more than has been vouchsafed so far about the policy which these units are supposed to follow in deciding who to accept. The point is particularly relevant to our debate this evening since it is not only a matter of moving prisoners direct from prison to one of these units, if indeed that is contemplated, but also a question of whom they may take, for example, from the special hospitals and thereby leave vacancies which can be filled by individuals moved there from prison. Given the minuscule number of places so far available, I do not suppose that there is very much practical experience to go on, but I assume, although we have not been told very much so far, that the Government have a policy about all this.
Moving on from there to territory which comes more directly within the province of the Minister who is to reply, I go along with what has already been said—that it was reassuring to learn from him that the number of convicted prisoners regarded as suitable for treatment in hospital has for the first time fallen below 100. That is indeed very reassuring news, but there are just one or two slightly puzzling features about this. For one thing, as the noble Earl has already pointed out, the chief inspector himself refers to rather larger numbers and says in terms that there is room for argument about the numbers. The May Committee said that for its part it had found it impossible to determine the exact numbers involved, but it duly recorded the figure which I think the noble Lord, Lord Avebury, has already given and which the prison medical service calculated at the end of 1978—that there were 389 such convicted prisoners.
Since then, the published prison department reports do not record any large increase in the numbers transferred. But these reports go up to only the end of 1983 and I wonder whether the total has been brought down so much by a dramatic increase this year? No doubt the Minister, if he has heard the point, will be able to answer it when he comes to wind up.
May I also ask him whether the same criteria have been used unchanged throughout, or whether there have been some changes in the criteria in the light of the 1983 Act, and whether this of itself has affected the figures? Also is he satisfied that reasonable consistency has been achieved over the whole widely scattered prison medical service? Are there obstacles to prevent this total of just under a hundred being much further reduced? Are there often delays in arranging a move once one has been decided on in principle?
There is the further point that the Minister's figures related to convicted prisoners, as I understand it. I wonder whether he will be able to tell us how we stand 363 as regards remand prisoners? I appreciate that since October the courts have had available to them the new powers in the 1983 Act to remand individuals to hospital for reports or for treatment. But I am also aware that the DHSS circular to health authorities made it clear that the courts were being told that they should not expect that places would always and everywhere be available.
I am sure it is too early for these powers to have had much impact on the prison remand population so far. I wonder whether the Minister will be able to give us some indication of the number of remand prisoners now in custody who would be better placed in a hospital, and what his assessment is of future developments, including the point of whether the regional health authority will always have someone in court to explain orally why they cannot help, if indeed they cannot help.
One other quite unrelated point I should like to ask is this. We have asked once or twice whether the Mental Health Act Commission has any role to play in this context. We have not had very clear replies. My own reading is that it falls outside their remit but perhaps the Minister will be able to give us an authoritative reply when he answers.
Finally—and here I really revert to the point made by the noble Lord, Lord Avebury—everyone has recognised, the Butler Committee included, that there are certain mentally disturbed prisoners who will have to continue to be treated in the prison system, come what may. Mention has been made of the dangerous, anti-social psychopath. Mention has also been made of certain life sentence prisoners. I have another one in mind who has now served over 30 years. At one stage he was in Broadmoor but the hospitals would not take him back. On the point made by the noble Lord, Lord Avebury, about the change in the law, as I understand it, before the law was changed it had been the increasing practice for the DHSS to refuse to take a prisoner if their advice was that the prisoner could not be treated. Incidentally, these cases to which we have all referred throw rather a lurid light on the popular myth that "life" means nine years.
I hope the Minister will have time, when he answers, to tell us a little more in elaboration of the points he hinted at the other day about what is being done at Parkhurst and at Grendon, the establishment with which I had some concern, and also about the specialist training of prison officers. It has always seemed to me that there is a major problem with some of these dangerous, disturbed prisoners, who are in the nature of things unsuited for any of the pre-release schemes, or for parole, and who, if serving a fixed term of imprisonment, come out at the end of it straight into the community without any preliminary preparation for the outside world and without any supervision. However, that is a separate issue which perhaps we need not pursue today. We have perhaps in this short debate raised enough questions for the Minister to answer.
I am bound to say that the Minister has quite a difficult role ahead of him, even though now supported by some reinforcements on his side of the House, in convincing us that things are now going reasonably well. I shall wait with great interest to see whether he succeeds.
§ 8.56 p.m.
§ Lord Graham of Edmonton
My Lords, paragraph 2.19 on page 8 of the report of Her Majesty's Chief Inspector of Prisons is the starting point of this debate. I am at one with the noble Lord who uses the first part of that paragraph as his text. But in my view, as was mentioned by the noble Lord, Lord Avebury, the latter part of that paragraph will also equally repay close study. I think it ought to be read into the record. It reads:Meanwhile, it is almost certain that there will always be some mentally disturbed offenders who cannot be admitted to mental hospitals and for whom alternative regimes need to be provided. The lessons to be learned at Grendon, particularly in relation to the breaking down of traditional barriers between staff and inmates, have important implications for the management of these and other prisoners, and are worthy of more general application".I know that we have a Minister here to answer our debate who is known as a caring Minister, one who is respected, none more so than among the members of the Prison Officers' Association, on whose behalf I perform a parliamentary liaison function; and I declare that interest tonight.
As the completed part of paragraph 2.19 shows, prison officers can play, do play, a crucial role within the prison community. When we as politicians make our decisions, provide our remedies, and instruct our servants to carry them out, it is the like of prison officers and governors and those of all other grades involved in our custodial service who are faced with the reality of making that system work.
The Minister will be listened to with great care and I believe with sympathy, sympathy from me not least because I sense his concern. I suggest his response can be anticipated with words like, "We know the problem; we know the solutions; we have insufficient resources". I believe we shall be chided for failing to acknowledge what has already been done. I do not fail to acknowledge this. I acknowledge with appreciation what has been done. We shall be chided for failing to appreciate just how much has been done with so little. But, as the noble Lord, Lord Allen, has said, unless we pressurise the Minister from our experiences and our responsibilities, who else will? In essence we shall be telling the Minister to urge his colleagues to do more, to do it better, and to do it more quickly.
Why do we feel constrained to do so? Our prisons are a reflection both of the ills of our society and of the priorities we have as a society in seeking to make our prisons better places. I would remind your Lordships that it is only a short time since the then director general of the prison service described the over-crowding in prisons as, "an affront to civilised society".
The case for specialist treatment in special places by specialists—qualified specialists—was never more clear than in the realm of the mentally ill or the mentally disordered. Pending the creation of that perfect state when the Minister has all the resources he needs to satisfy society that all that can be done is being done, can the Minister satisfy the House that the best use is being made of human resources? In these establishments, where these unfortunate individuals are placed, what care and concern is shown to see that non-specialist but specially trained officers are given additional training, advice and guidance? When the additional burden to secure these individuals safely 365 —security for other prisoners, officers and themselves—is made, is the Minister satisfied that all that needs to be done is being done?
Together with other noble Lords, I had the satisfaction of listening to the Chief Inspector of Prisons, Sir James Hennessy, when he spoke on the work of his department to a meeting of the Parliamentary All-Party Penal Affairs Group here in Westminster last night. Let me tell the House that, on first impresssions, I was impressed by what he told us, and so were other noble Lords. As the Minister knows, I deliberately avoided raising any aspect of that part of his report which forms the subject of our debate tonight. I would, however, ask the Minister to recall that I did quiz the chief inspector on the frequency of his inspections, bearing in mind that the crux of his purpose in life, as I see it, must be to visit, to report and to recommend, and to start all over again, almost like the painting of the Forth Bridge.
The Prison Officers' Association tells me that it could take 10 years to complete inspections. And this, in part, was borne out by Sir James last night when he stated that it will be the turn of the decade before a first visit has been made to all of the establishments. If the gravely disquieting state of affairs in paragraph 2.19 exists after a short period—"In previous reports we have expressed our concern", "frequently told us", "inappropriately confined", "many Governors" and "hardest part of their duties" are some phrases from that tiny bit of the report—how many other wretched individuals are in prisons that may not be visited for three, four or even five years? What is the Minister doing to shorten their inappropriate confinement?
Sir James touched briefly on the desirability of the undertaking by prison officers of a greater share of social work in prison establishments—a policy, I might add, advocated by the Prison Officers' Association for more than 20 years and one which, on the margin, can contribute greatly to changing the atmosphere, relationships and, yes, the possibility of mental illness being fostered or avoided in our prison community. The Minister will not need me to remind him that Sir James could only applaud the promotion of social projects within the prison service while regretting that continuing manpower shortages universally throughout the service meant that little progress was being made to extend social work and thus to help to reduce tensions. Can the Minister tell the House anything helpful concerning progress towards placing the 5,000 additional prison officers now authorised but which seem painfully slow in materialising?
Sir James reports, and my noble friend Lord Longford uses as a text for this debate, the view of prison medical officers that managing mentally ill offenders was the hardest part of their duties. If that is the view of those who are in close contact with those disturbed people for short periods, just imagine the effect that much longer sustained continuous periods must have on those who have to care for them at all times, the prison officers. My noble friend draws attention to the many individuals who require additional care although outwith the terms of the Mental Health Act 1983. Although not covered, they require the time and patience of prison officers to master such simple social tasks as how to shave, how 366 to wash and how to eat. No doubt, the Minister has had his attention drawn to the article in The Guardian today, a powerful cry by Kilian Zumpe entitled: "The mad world of the Mental Health Act". References have already been made to it. Time does not permit a critique. Certainly, I do not expect the Minister to respond to the article tonight. The article is both daunting and haunting.
In his report, Sir James had this to say concerning conditions within the prison community today. Paragraph 4.01 states:It is easy to forget that the conditions in which prisoners live are also the conditions in which prison staff have to work. Thus the overcrowded prisons we described in the last chapter make life uncomfortable not only for the inmates but also for prison officers. Although staff working conditions have improved in recent years such improvements as our inspectors have noted have not been matched by the general application of modern technology".Paragraph 4.04 states:At every establishment we inspected in 1983"—note, my Lords, the words "at every establishment we inspected in 1983"—we discovered that the number of staff in post was below the authorised staffing level. The shortfall ranged between 7 per cent, and 26 per cent, with the average being around 16 per cent".That is the shortfall in establishment.The Inspectorate does not have the resources to carry out a detailed evaluation of manning levels in an establishment or to assess accurately the efficiency with which the available manpower is deployed. It is difficult for us, therefore, to be sure about the apparent need for additional staff, or to know whether, as some commentators have suggested",there are further requirements.
Paragraph 4.06 states:One of the more serious effects of the apparent shortage of staff in the Prison Service today is the level of overtime worked by prison officers".Other references are made to shortages of staff which must have a bearing on the ability of the prison service to fulfil successfully all its responsibilities. I draw those words from the report that we are discussing tonight to the attention of the House and of the Minister. Not that I believe he is unaware of them, or that he does not have great difficulties in trying to do something about it. I do so because the problems so powerfully portrayed by my noble friend Lord Longford must be seen in the broader context of the state of the prison service today.
I happen to believe that the Minister in charge of the debate cares about these things. He demonstrates this time after time. Strictures made tonight are more designed to strengthen his hand when seeking additional resources to put things right than to lay blame at his personal door. My noble friend Lord Longford has helped the House and, I believe, the Minister not only in raising these issues but in reminding us of statements made by the Minister and his ministerial colleagues. He also uses illustrations from his own knowledge and experience to support his anxiety.
I have been given some extracts from reports of inspections of prisons which I feel are germane and show the kind of situation which will continue to worry all caring people. I have here an extract from the report by the inspectorate on Parkhurst. This is what it says:We received a number of comments from staff about the loss of the medically-orientated unit in C Wing following the 1979 inmate 367 disturbances. This small unit, which was first taken into use in 1970, provided a regime for the care, training, management and treatment of prisoners with particularly difficult behavioural problems. It seemed to us that it had proved its worth as a means of enabling the staff to respond to the needs of a particularly difficult section of the population in an environment which kept tension to a minimum. We were disappointed that it had not yet proved possible to reinstate the unit".I have made inquiries and understand that improvements have been made in the situation since this report, which was made in 1982, was submitted. But I understand the situation has not improved very much.
I have here a report, made in 1983, on a visit to Ashford. It says:Some of the discipline staff in the main wings of the Remand Centre had encountered difficulties in dealing with mentally disturbed prisoners, and we felt that greater use should be made of the hospital to care for these inmates, particularly since some accommodation was available there. Discipline staff would also benefit from guidance and close support from the medical staff in their dealings with those disturbed inmates whose condition was not sufficiently serious to justify admission to the prison hospital".That is the very issue we are discussing tonight. The report continues:More generally, Ashford encounters the problem common to so many Prison Service establishments of gaining entry to NHS psychiatric facilities for inmates who are mentally disturbed".I believe those reports are germane to the subject we are discussing tonight.
I wonder if the noble Lord would take on another aspect which is not related directly. Does the Minister understand the dilemma, the anguish and the despair of many magistrates—my wife is one—who have to deal with and sentence mentally-ill people when, for instance, Friern Barnet and Claybury mental institutions, which are within the area in which we work, in our part of the world, are slowly but certainly being squeezed out as an option which may be available to them?
In conclusion, I should like to say that I can think of nothing worse than being in prison. I can think of nothing worse than suffering a mental disorder. To have those two sorry states compounded—to suffer the disorder while in prison—is bad enough, but to do so and not have access to proper and remedial treatment must surely be depressing and agonising in the extreme. The Minister will know that his concerns are shared by many others, not least prison officers. They want to be more than just the turnkeys of yesteryear. They have a constructive role to play in general but especially in looking after those in their charge who are unfortunate enough to need psychiatric care. Tonight the Minister can go some way towards assuring the whole prison society that he has plans to bring relief, and not only plans but the will and the resources to put those plans into effect.
§ 9.12 p.m.
§ Baroness Ewart-Biggs
My Lords, in putting this Question before your Lordships this evening my noble friend Lord Longford has very rightly focussed attention on the plight of a particular group of people who are really among the least fortunate members of the community. He has also brought to light the failure to deal satisfactorily with their tragic situation. We have benefited from the highly specialised knowledge 368 of the noble Lord. Lord Avebury, and the noble Lord, Lord Allen of Abbeydale, who with his background of expertise and very great experience has put some very searching questions to the Minister. I know that we all look forward very much to hearing the answers the Minister will be giving.
I certainly do not feel that I am in a position to add anything to the extremely expert evidence given by the two noble Lords. My noble friend Lord Graham has put the case from the prison officers' point of view. I know how very grateful we are to him and how very useful it was to hear the whole case from that particular aspect.
Therefore. speaking from the Front Bench in support of my noble friend, I should merely like to make a few general points which represent the anxieties expressed by the National Association for Mental Health. I should also like to describe the circumstances surrounding one particular case involving the detention of a mentally abnormal offender of which I have personal knowledge.
First, I should like to put forward the points raised by the National Association for Mental Health, which is obviously extremely concerned about this particular area. The association has given some figures and I should be grateful if the Minister would confirm them. The figures given by MIND are as follows. The number of persons in prisons on 31st March 1984 formally identified as mentally disordered was 310, of whom 144 were sentenced and 166 were on remand. The association points out that in many cases psychiatric care in prisons for these persons is inadequate or non-existent. That point was borne out in the report of the Chief Officer of Prisons.
The association also has considerable concern about conditions in Holloway Prison and would like to express the shock it feels about the lack of psychiatric care in particular cases which have been referred to its own legal department. There is no doubt that certain conditions in Holloway have found their way into the press and we have heard of horrific incidents where women have injured themselves and are quite clearly in very serious need of psychiatric care.
The association emphasises the point which has already been made by noble Lords that all mentally disordered patients must be treated and transferred to hospital if necessary without delay. The association points out. as has been said, that many transfers do not take place or are delayed due to lack of appropriate beds. The association also stresses that it is important that Sections 35, 36 and 38 of the Mental Health Act 1983 should be used to identify the needs of offenders and accused persons before prison sentences are passed. It feels very strongly that appropriate disposal by the courts is crucial.
Although the sections that I have mentioned became law on 1st October 1984, the association has been made aware that in some cases hospitals have been reluctant to accept accused persons under Section 35—which is the section which relates to remand to hospital for a report on the mental condition of the accused. Finally, the association emphasises the desperate need for an efficient and effective transfer system to enable hospital care to be made available for prisoners, which, as I have said, is 369 a point which has been put forward in detail by previous speakers.
I should also like briefly to describe the circumstances surrounding one particular mentally abnormal offender who was brought to my notice. I do not have the experience and expertise of the previous noble Lords who have spoken. However, when speaking to friends in a community health council in Leeds I was told the circumstances of a particular case which brought this problem very much to a head as far as I was concerned. The particular case concerned a 44-year old mentally handicapped man with a personality disorder. In 1982 he had spent time in a mental hospital, but in June 1983 his elderly mother, who is also mentally disturbed, contacted the community health council for advice. She told the council that her son had been sentenced for an offence and put into Armley Gaol. But her major concern was as to what would happen to him after his release in November. This really relates back to the point which has been made about what type of care can be given to people who have been in prison and who then come out and find that their families are unable to cope with them. I was told how very often the families of mentally disturbed people who have been detained are themselves of a disturbed nature and are often from deprived backgrounds.
However, as I have said, the mother telephoned the council daily and described how her son's condition had seriously deteriorated in prison and clearly she was in no position to cope with him on his release. The council, recognising that their function is in relation to the National Health Service and not to the Prison Service, informed the probation officer, who met the released prisoner at the prison gate and arranged for him to be taken back into the mental hospital where he had originally spent some time in 1982. The patient was then released, and his elderly mother remains in a state of deep anxiety as to what will happen to him next.
Resulting from this, however, the Leeds Community Health Council decided to find out what was the situation regarding mentally ill offenders in Armley prison, and wrote to the Home Office asking for this information. Eventually, in December 1983, the council received an answer to their letter written in June, and this appears to me to be a strangely long interlude. I can appreciate that it was not the business of a community health council, but nevertheless they were there trying to help this particular person. They then got the information that there were nine offenders categorised as mentally disordered who were in the prison on remand, and they were told that there were no transfers pending. So here were nine of the mentally disordered offenders who, in the words of the Chief Inspector of Prisons, were inappropriately confined to prison.
I find surprising the case of the community health council who were trying to help this particular family and I also find surprising the interlude of six months before they received a reply to their letter. This particular instance, however, brought home the full reality of the isolation of this small group of unfortunate people and the great feeling of being alone which they and their families must have. So many of the families are unable to cope with the problem of 370 dealing with a relative who is in this particular situation, and one wonders who there is to intervene on their behalf. It is for that reason that we are so grateful to my noble friend Lord Longford for taking the opportunity this evening to intervene on their behalf. It is for that reason that I hope the Minister will make a positive and helpful response to what the inspector said in his report and will also give positive answers to the many complicated points which noble Lords have put to him this evening.
§ 9.24 p.m.
§ The Minister of State, Home Office (Lord Elton)
My Lords, I certainly shall not satisfy your Lordships tonight, and that is for a number of reasons. One is that I am not now satisfied myself, and no responsible Minister could rest content with a position where any people who ought to be in hospital are in fact in prison. But for reasons which I shall go into I fear that on that score it is unlikely that any of my successors will be fully satisfied, either.
Another reason is that I have never, in the compass of so short a debate, received so many questions. I should like to thank those of your Lordships—and in particular the noble Lord, Lord Avebury—who have been kind enough to give notice of your questions and who therefore have a better chance of getting an answer than those who have not.
Further, I would say that the noble Lord, Lord Graham of Edmonton, widened the debate just a fraction, to put it, quite legitimately, into the context of the whole range of staffing, inspectorial and resource problems which the department now faces. I cannot entirely rise to the challenge which he puts before me, however, because of the constraints not only of time but also of the Order Paper.
I remind those of your Lordships who will not tonight get replies to your questions of the comforting and new tradition that the answers which I am bound to send you will be deposited in the Library, so that each of you can see what I have said to the other and, as a result, doubtless make my life difficult again on a future occasion.
The noble Earl has raised a very important issue. It is a very difficult one as well, as he has rightly said, and for many of the individuals concerned it is a tragic one. It is particularly apt because, borrowing the words of the Chief Inspector of Prisons, it concentrates on the question of what is appropriate. Too often it is assumed that the problem of dealing with prisoners who need psychiatric care is a purely mechanical one; that it consists only of providing adequate resources and passing effective laws.
That is not the only misapprehension. Let me quote Dr. Peter Scott, one of this country's most distinguished forensic psychiatrists, who bears me out.Most people",he said,harbour the basic fantasy of, on the one hand, a warm liberally equipped and permissive hospital system where treatment is applied by doctors and nurses to persons who are suffering through no fault of their own; on the other hand are the prisons where people are punished for wicked behaviour which they could renounce if they wished, and who should therefore be prepared to accept rigorous conditions and custodial turn-keys. Obviously,371 he went on,neither side of the picture is correct".It is tempting, and it is even comfortable, to say that if a prisoner needs psychiatric care and attention, or even if he might benefit from it, he ought to be in hospital and not in prison, as though that disposed of the matter. But it does not. Detention in hospital raises moral questions every bit as thorny as detention in prison, and sometimes even thornier, since they involve questions of medical ethics, such as the implications of detaining somebody for treatment which could well have been refused while at liberty.
My Lords, we debated this very issue long and intensely during the passage of the Mental Health Act. As a result, Parliament then decided that it would be wrong to transfer a prisoner to hospital and to detain him there for treatment, whether he liked it or not, unless there were very clear grounds for doing so. Accordingly, the only grounds provided under the Act are that the person in question is suffering from mental illness. psychopathic disorder, mental impairment or severe mental impairment which is of a nature or degree which makes detention in hospital for treatment appropriate; and, in the case of psychopathic disorder or mental impairment, there must be evidence that treatment is likely to alleviate or prevent deterioration of the condition.
I want to make it quite clear that this means that we cannot, in law, transfer to hospital under this Act a prisoner with a personality disorder, if his or her condition does not constitute a mental disorder in the terms of the Act; nor can we transfer a prisoner who is suffering from a psychopathic disorder or mental impairment if it cannot be treated in the sense of alleviating the condition or preventing deterioration; nor can we transfer a prisoner who is mentally ill unless the condition is of a nature or degree which makes detention in hospital for treatment appropriate.
This is not an accident of drafting; it is not the result of expediency; it is the considered view of successive Governments, and of Parliament itself, of the extent to which it is morally right to detain people in hospital against their will. Of course we then have to consider how those who cannot be transferred should be treated in prison. I shall turn to that in a moment.
But I should like, first, to explain what we are doing to transfer those who meet the criteria of the Mental Health Act. The Home Secretary stated at last year's Conservative Party conference that prison is not the right place for such offenders and that he was determined that all possible progress should be made in finding them hospital places.
Considerable progress has since been made in this, particularly in relation to sentenced prisoners. Since 1977 prison medical officers have every six months taken a census of prisoners whom they considered to be mentally disordered within the terms of the Act; that is to say, prisoners who are not only disordered, but who also satisfy the criteria for transfer to, and detention in, hospital. I readily accept that those who are not transferred were inappropriately located in prisons; and that is a direct answer to the direct question of the noble Earl.
372 The noble Lord, Lord Avebury, asked me to go back a little. In March 1983 the figure for the sentenced section of the number of people was 160. I might say that we started on 30th June 1977 with 517. I think the noble Lord wanted me to begin with March 1983, and we were then down to 160. On 29th September 1983 there were 118. There was then a kick in the graph to 144 on 31st March 1984. On 30th June this year the figure was 102, and on 30th September this year it was down to 91. Those are I think encouraging figures. Of course I am not happy while the 91 remain, but it would be a formidable task to move them, and I shall return to that point.
The noble Lord, Lord Allen of Abbeydale, asked me about the unsentenced figures.
§ Lord Allen of Abbeydale
My Lords, I asked whether the criteria had been changed. The Minister explained that new tests were imported by the 1983 Act. Does that of itself mean that the numbers were reduced, that some who were regarded as eligible before that Act was passed are no longer regarded as eligible because the rules have been altered?
§ Lord Elton
My Lords, I was coming to that after the figures. I shall find my note now and not read it out twice.
The 1983 Act incorporates an additional requirement into the criteria which the courts have to apply before they can make a hospital order. In the case of offenders suffering from psychopathic disorder or mental impairment, the courts must now be satisfied, as I have already said, that treatment must be likely to alleviate or prevent a deterioration in this condition. Although on the face of it this might seem to present an additional obstacle to securing the admission of such offenders to hospital, in practice it does no more than give legislative recognition to the medical criteria which were already applied in practice under the 1959 Act. Indeed, most of the decline in recent years in the number of hospital orders with restrictions made by the courts can be accounted for by the fall in the number of recommendations in respect of persons suffering from mental impairment or psychiatric disorder.
Having said that (the noble Lord will see why I was going to put it the other way round) I have to read the figures for the unsentenced part of the table, the first half of which I gave to the noble Lord, Lord Avebury. The March 1983 figure was 159: in September 1983 it was 198: the figure in March 1984—that is, this year's figure—was 166: the June figure was 150 and all those figures are much of a muchness. We come in September this year to 192. It is notoriously dangerous to deduce anything from one sampling figure and that kick in the graph is, on its own, no more alarming than the others that I have recited. If it is repeated, that is a different matter, but it is too early to say.
As I say, the reduction is particularly striking in relation to sentenced prisoners. I have given your Lordships those figures already. There is concern about the length of time that it takes to complete a transfer, but in the case of nearly half the 150 prisoners transferred in 1983 the Home Secretary's direction for transfer was issued within one week of the receipt of the recommendation. Nevertheless, we are not 373 complacent and both the Home Office and the Department of Health and Social Security are making continued efforts to reduce the problem further.
§ The Earl of Longford
My Lords, I want to interrupt the noble Lord as little as possible, but does he intend to deal with the statement of the Chief Inspector that there are many mentally ill people who are inappropriately confined? Does he intend to deal with that or has he somehow managed to sweep it aside?
§ Lord Elton
My Lords, I gave a direct answer to the noble Earl's direct question. I think he was doing what I often do when I do not answer a question and that is writing down a note of what I had said just before. But as soon as I came to the figure of 91 at present in prison, who it is agreed should not be in prison, I said that I readily acknowledged that they were inappropriately contained. The noble Earl will want me to go further and say whether what we do for people who are in prison is in itself appropriate. That is what I want to do next.
§ The Earl of Longford
My Lords, forgive me but the noble Lord really has not answered my point, except in a way that I can hardly credit him with. When the Chief Inspector says that there are many people among the 40-odd thousand people in prison who are inappropriately confined because they are mentally ill, he cannot expect us to suppose that the Chief Inspector meant that there were 91 people.
§ Lord Elton
My Lords, on the other hand the noble Earl might be expected to assume that the figure of 183 people was "many people" and those are the figures which I gave. We could spend some time debating the others. As convention does not allow me to speak much longer and I have much more to say, I think it would be most useful if I proceeded with this material and perhaps tried to return to the other, if there is time enough at the end of the debate.
We are particularly concerned about unsentenced prisoners (to whom I referred) since these now comprise over two-thirds of the total of prisoners assessed as mentally disordered within the terms of the Act. This reflects the fact that, until recently, the powers for transferring unsentenced prisoners to hospital were rather narrower than those which apply to sentenced prisoners. There may, too, have been some wariness of appearing to influence the court's eventual decision.
But on 1st October this year we brought into force new provisions in the Mental Health Act 1983 which specifically address the problem of unsentenced prisoners. These give the courts new powers to order remand to hospital for a report on an individual's mental condition or for treatment, and to make interim hospital orders. The Government believe that these powers will make it easier to find places for such offenders by enabling the hospitals to evaluate them on a trial basis. We therefore hope for a gradual reduction in the number of unsentenced prisoners in the six-monthly census.
Another important provision is Section 39 of the Act which came into force on 30th September 1983. This requires regional health authorities to give to the 374 courts on request information about hospitals which could provide accommodation for offenders in respect of whom the courts are considering hospital orders. This should help the courts to establish what facilities are available and also which is the appropriate hospital catchment area. Officials of the Department of Health and Social Security have had detailed discussions with senior officers of the National Health Service authorities, consultants and senior nursing staff from individual hospitals, directors of social services and prison medical officers about the problem of "difficult to place" patients generally—and into that category fall some of the people the noble Earl referred to—and ways of making the required facilities available.
The effectiveness of Section 39 is being closely monitored and we hope that the new arrangements will reduce the number of cases in which, although a hospital order appears appropriate, the court is unable to find a place. Only 20 referrals were made under this section in the first nine months of this year, and the average time it took to place in hospital such patients, who were found to be mentally ill within the meaning of the Act, was just under four weeks.
As another part of our effort to get the best out of this Act the Home Office is examining the cases of those prisoners in one of the recent surveys who were assessed by medical officers as mentally disordered, and detainable under the Act, to check whether recommendations for transfer have been made, and if not, why not. Where recommendations have been made but there has been difficulty in finding a place we are informing the DHSS in order that they may look inot the matter. We believe that this will help ensure that the census both concentrates on those who can be transferred to hospital and is itself a spur to action.
Noble Lords have for long been interested in regional secure units as places of containment for those for whom prison is not appropriate. Significant progress has been made recently with them. The noble Earl correctly quoted figures given to your Lordships by my noble friend Lord Glenarthur. Seven permanent regional secure units are now open. These will eventually provide a total of 264 places, of which about 120 are now staffed and available. I should add that in most of the units the places are being brought into use in stages. Two further permanent units, providing a total of 51 places, are complete but not yet open. Both units are expected to admit their first patients in the spring. The South-East Thames multi-site scheme, which comprises five units, providing a total of 90 places, will be completed by the end of this month. All five units are expected to admit their first patients in February or March 1985. In addition, two permanent units, providing a total of 128 places, are under construction and are expected to be completed during 1985. Four further permanent RSUs, providing 175 places, are at various planning stages.
We are therefore now seeing real progress across the country in the establishment of RSUs. Nationally nearly 500 places are expected to be completed in permanent RSUs by early 1985 and, as the noble Earl has said, nearly 650 by the end of 1987. He smiles, because I am running on what he regards as predictable tramlines, and he is thinking back to the departure point of the interim Butler report in 1975 which was studied in conjunction with Dr. Glancy's 375 DHSS working party report which followed it very shortly. Butler saw a need for about 2,000 beds nationally. Glancy saw a need for about 1,000 beds nationally. Following due consideration, the department concluded that initially regions should be asked to create sufficient beds to meet the Glancy requirement of 1,000 and review the situation when the programme had advanced. The department's RSU policy is based essentially on the Glancy principles.
That wil achieve an even sharper focus if I tell your Lordships that at any one time there are, as I understand it, about 100 of these beds taken up. As to the proportion of them that are taken up by people who have been transferred under Sections 47 or 48 of the Mental Health Act 1983, I shall have to write to the noble Earl, but the fact remains that there is actually room in the system already, and as we increase our ability to transfer prisoners out, so the accommodation will become available to receive them into the system. Therefore I hope the noble Lord will feel that the tramlines on which I have been travelling have arrived at a useful point.
As we are on the subject of security, if for no other reason, I might just mention the length of time which people may be expected to spend in the high security cells at Wakefield. I think it was the noble Lord, Lord Avebury, who asked me whether, if it was to be indefinite, the prisoner should not be told so. We have no intention that it should be indefinite, because we think this is something that ought to be reviewed as a regular precaution; and in fact the Director General does review each case annually. I think the noble Lord had it in mind to ask me about the position of one RJM. His review has recently been completed and the intention is that he should stay there. However, it does not follow from that that he will stay beyond the next review, when again his case will be looked at on his merits, if that is the right term.
On the question of who should be admitted to regional secure units—that was asked by the noble Lord, Lord Allen of Abbeydale—our view is that decisions on admissions are for those running the units to take, having regard to the particular behavioural problems of individuals the majority of whom are likely to be suffering from some form or other of mental disorder, and their likely response to treatment. It is expected that patients will remain in a unit for not longer than 18 months to two years.
I think at this point I must briefly pause to pick up the challenge which the noble Earl has been throwing before me constantly and say that there will always be a difficulty about placing patients, because it is not the function of the Prison Service or of the Secretary of State at the Home Office or the Secretary of State for Health, or indeed for Parliament, to tell an individual doctor or medical team that they must contain an individual patient. Their job is to treat. The first thing the Act requires is that treatability should be established. The second thing is that the doctor must himself decide whether he is able to treat. I see from the position of the noble Lord, Lord Allen of Abbeydale, that I am in danger of precipitating a debate such as we had on the Mental Health (Amendment) Bill, as it was, some 2½ or 3 years ago; but the fact is that doctors cannot be compelled to 376 keep secure people whom they do not themselves feel able to treat, because you are then asking them to do the job which is in effect the job of the Prison Service; and one cannot direct them. If the noble Lord wishes me to give way, I will—but briefly, because I am going to be in very bad books with the Chief Whip, if I take too long.
§ Lord Allen of Abbeydale
My Lords, I wanted merely to say that there is a well-understood policy as to who goes to Broadmoor, Rampton and the other two special hospitals. One would hope that there might be a similar policy for the regional units: evidently there is not.
§ Lord Elton
My Lords, I think this is something which may develop in time, but at the moment every case is carefully discussed. It may be that, with experience, those in the newer RSUs will come to recognise the cases and some transfers will be made as a matter of course, but that is an aspiration and not a prediction.
I am bound to discard some material. I think that the arrangements for transferring prisoners to hospitals under the Mental Health Act are now working more effectively than they were. That is not to say that the system is perfect or that the noble Earl will be satisfied, and it is right that noble Lords should keep harassing the Government to continue to improve their performance. We now have more places for difficult patients than we did have, and we have reason to expect further progress; but this does not dispose of the problem. There will always be, as the noble Earl has reminded us and as the chief inspector has also reminded us, those who though clearly disturbed are not diagnosed as suffering from mental illness or one of the other forms of mental disorder warranting detention in hospital under the Act, and who must therefore be detained in prison. The purpose of my aside to the noble Lord, Lord Allen of Abbeydale, was to give some indication of who those people would be.
These cases do not comprise a homogeneous group. It includes a few who are very disturbed, perhaps aggressive or even dangerous, but a larger proportion who are suffering from difficult though less aggravated conditions: for example, the burnt-out schizophrenic, whose condition is no longer deteriorating but whose behaviour can be bizarre and who needs careful management, those with behavioural problems over which they need help and others who have no underlying mental problem but who may be seriously depressed or very anxious from time to time.
The group of prisoners with psychiatric problems for whom transfer to hospital is not, in the words of the Question and the Act, "appropriate", is a very mixed one and it follows that there is no single right way of treating them. Many are capable of serving their sentences in an ordinary prison location unde regular medical supervision. Others need to serve shorter or longer periods in a prison hospital. Of course, the presence in the prison system of a sizeable proportion of prisoners who need psychiatric care and attention, some behaving in bizarre and threatening ways, places a great burden on staff.
I pause here to endorse everything that was said by the noble Lord, Lord Graham of Edmonton, about the 377 staff, because here I am talking about the prison service as if it is some sort of machine which will take on any task with which the hospital service does not feel itself able to cope. That is not just a statistical or management problem; it is a very deep, testing and personal problem for the people involved in the case. I am very much aware of the extent to which the service and society as a whole, and indeed the prisoners themselves, are indebted to them.
It is a measure of our recognition of this task that we decided last year to double the initial training period for prison hospital officers and to devote the extra time entirely to aspects of the care of mentally disturbed prisoners. The course was 12 weeks—
§ The Earl of Longford
My Lords, my point is on that. It is a question of fact. Would that apply only to officers in special hospitals or in prisons?
§ Lord Elton
My Lords, that would be prison hospital officers across the board. I really think, with your Lordships' indulgence, that I must not give way again, however negligent I have been in making points.
Then there are the medical officers. Almost one-third of our medical officers hold psychiatric qualifications. Most of them have a great deal of experience of psychiatric work. In addition, prisoners have access to National Health Service facilities through their medical officers. In 1983 nearly 11,000 prisoners were referred to visiting psychiatric specialists, and more than 2,000 to consultant psychiatrists. So prisoners have available to them considerable psychiatric resources from both inside and outside the prison service. But there are clearly some mentally disturbed prisoners who cannot themselves cope with an ordinary prison environment or who cause problems for other prisoners and staff because of their unstable and aggressive behaviour.
The noble Lord, Lord Avebury, referred to a number of cases. If I do not deal fully with them, I will endeavour to write to him. On the case of the prisoner whose initials were D.J.L., he is to be seen by an assessment team from Park Lane hospital in order to determine whether he is suitable for admission to that establishment. When they indicate the date on which they can assess the prisoner, the necessary arrangements will be made. The medical officer at the prison where this person is currently located considers that it is in his own interests that he should be on normal location, but this does not in any way prejudice consideration of a transfer to a special hospital.
The noble Lord, Lord Avebury, also referred to a prisoner whose initials are J.S.B. He has been in Parkhurst since March 1982 and reports, including a medical report, on his progress there were received in the Home Office a couple of months ago. In accordance with the revised procedures for dealing with life sentence prisoners announced by my right honourable friend in November last year, we have recently sought and received the views of the judiciary on the period of detention they believe appropriate to 378 the offence. My right honourable friend has, in the light of those views, decided the date of the first reference of the case to the local review committee, and the decision will be made known to him shortly. There is nothing in the recent medical reports to suggest that he needs treatment in a special hospital.
The noble Lord asked about a prisoner, Mr. A.G.D. He has been reviewed for parole, as the noble Lord will recall from correspondence, on eight occasions—the first in 1969 and the last in 1982—and on no occasion has parole been authorised. Unless there are developments in the coming months which indicate otherwise, the case will be referred to the local review committee again in October 1985. He is at present accommodated in the hospital at Parkhurst. Should his condition deteriorate to the extent that he needs to be transferred to a mental hospital this can be done.
The noble Lord had an interesting idea which I believe sprang from that case. He suggested there could be something equivalent to the Mental Health Review Tribunal in the event of a prisoner being detained beyond what is the recognised tariff for his case. I should be very rash indeed to say more than that it is an interesting idea which I will take away. I think he can see that there would be statutory difficulties as well as administrative ones. However, I am obliged to him for suggesting it.
I regret that I am not going to be able to say all that I wish. Noble Lords know that we are pressing ahead with C Wing at Parkhurst. I think that some of our most harrowing cases come through the C1 Unit at Holloway prison. That unit has recently been the subject of interest and your Lordships may wish me to spend just a few moments on it. It can hold 46 inmates. The average number held there is about 40. It has 26 single rooms and four dormitories holding five women each. When it was first opened in 1977 it had the primary function of holding and caring for the most disturbed women received into Holloway. This included women who were psychiatrically ill and those whose behaviour or mental state was clearly disturbed—as shown by the difficulties they presented in the management of their persistently disruptive behaviour—but who were not considered to he suffering from mental illness. It was also used to hold women needing special supervision because of the nature of their charge.
Over the years the pattern of allocation to the unit has changed and it now accommodates up to 90 per cent. remand prisoners, most of whom are there for medical assessment and reports to courts. A majority of the inmates on the C1 Unit are diagnosed as being mentally ill. The daily routine follows the normal timetable for the rest of the prison. However, rather than being required to work, all women who are fit enough go to the skills training unit, formerly an occupational therapy unit, which is staffed during the working day by a mix of civilian instructional staff, discipline officers and nursing staff. I am sorry to say that staff shortages sometimes preclude the operation of the skills training unit and the staff then habitually go to the C1 Unit to give instruction there.
The C1 Unit is a medical unit and is under the direction of the senior medical officer. Additionally, a consultant forensic psychiatrist and his senior registrar oversee the psychiatric care of the women by 379 contributing five and four sessions a week respectively. The previous medical director of Broadmoor contributes three sessions a week to Holloway, including C1 Unit. One of the full-time medical officers who is also a psychiatrist contributes when required. The unit is staffed jointly by nurses and prison officers. It also has the services of the probation, psychology, chaplaincy and education departments and the staff of the skills training unit.
The majority of the women on the unit are very disturbed and require a caring and supportive environment. Many are considered to be at risk of injuring themselves. The study revealed that although 59.1 per cent. of the women had been thought to be at risk of harming themselves, the rate of serious self-injury was lower: 6.8 per cent. of the women were officially recorded as having injured themselves. I am aware of recent horrific cases of self-injury on the unit. I am glad to say that all three women concerned have since been transferred to special hospitals. The staff at Holloway responded in a most caring and professional way to these very distressing incidents.
Holloway does not, of course, consist simply of one specialist unit for seriously disturbed prisoners. It is, in fact, a big London prison attempting to discharge a variety of functions. It has an extensive remand commitment and it contains a number of other specialist units as well as C1. There is no doubt that its population includes a number of seriously disturbed and difficult prisoners. The redevelopment of Holloway has been going on for a number of years, and during that time ideas about the treatment of prisoners have changed a good deal.
We believe that the time has therefore come to review in some detail what the role of Holloway Prison should be within the women's prison system. We have therefore decided to set up a project committee to look urgently into these matters. The committee will be under the chairmanship of the Regional Director, South East Region, Mr. Colin Honey. Members will be drawn from both within and outside the department. The committee will begin work straight 380 away, and will report to the director general of the prison service within about six months. I should say that my right honourable friend the Home Secretary takes as close an interest as I do in this matter. We are convinced that a fresh look at Holloway is needed, and confident that the project committee will be able to set Holloway Prison onto a new course.
I have no time to speak of the provision in the young offender service. I have to say that the Government agree that it is inappropriate that prisoners who are mentally disordered, and detainable in hospital within the terms of the Act, should be in prison. Good progress has been made in transferring them to hospital, but it is not yet complete. I cannot agree that we are or have been in any way complacent, as the noble Lord suggested. Nonetheless, to turn the question round, we recognise that there are others whom it would be equally inappropriate to detain compulsorily in hospital for treatment, either because treatment can be carried out equally well in prison or because their condition cannot in the present state of medical knowledge be treated at all. Those are the remainder who will always demand compassion of your Lordships, of prison visitors and of staff.
I conclude by thanking your Lordships for your compassionate concern. I repeat the great regard that I have for the staff who handle these sometimes appallingly difficult and very dangerous prisoners. It takes courage as well as patience and compassion to handle them. The answers to the many other questions that remain will appear eventually in your Lordships' letter-boxes.