Mental Health Act 1983: Hospital Admission (Hansard, 28 November 1984)

§ Lord Broxbourne
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Glenarthur)
Yes. my Lords, we are generally satisfied.

§ Lord Broxbourne
My Lords, in thanking my noble friend for that Answer, may I ask whether he is aware that perhaps he is a little too easily satisfied? Has his attention been drawn to the recent observation of Judge Verney, in sentencing a mentally disordered woman, that: It is a scandal that people like this woman have to be sent to prison because there is nowhere else to send them"? My noble friend is too enviably youthful to recall the high hopes that animated us at the time of the introduction and passage of the Mental Health Act 1959. But does he not think it regrettable that provision of facilities for implementation lag so far behind legislative intention?

§ Lord Glenarthur
Yes, my Lords, I am aware of the remarks to which my noble friend has referred. But I am sure that, with his experience, he will realise that cases which hit the headlines in the way that this one 898 has done are often more complex than they in fact appear from the reports in the media. The courts can have difficulties where, for instance, there is a conflict of medical opinion, but the aim of legislation is to ensure that only those unfortunate people who really need, and will benefit from, treatment are compulsorily detained in hospital. I share some of the misgivings which my noble friend expresses, but there are problems such as I have described, of which I am sure he, too, will be aware.

§ Lord Kilmarnock
My Lords, how many orders of the type referred to in the Question have been made since the coming into force of the Act, and have the hospitals been able to respond? How many people have had to be detained in custody, and for how long, pending a suitable hospital place? Is it not a scandal that a mentally disturbed female arsonist should recently have had to be sentenced to life imprisonment?

§ Lord Glenarthur
My Lords, I cannot give those figures without notice. The answers to the. second part of the noble Lord's supplementary question were given in reply to my noble friend.

§ Lord Ennals
My Lords, if the Minister cannot answer that specific question—which was, how many who ought to have gone to hospital for treatment have gone to prison, where they cannot receive treatment—is that not a very unsatisfactory situation? Is the noble Lord not too easily satisfied by a situation in which, surely he would agree, a number of regional health authorities do not have suitable accommodation, whether it be special hospitals, regional secure units, or hospitals with secure wards? As he looks at his notes, is he not able to find out and to say how many such people have been sent to prison? Is it not clear that since the Mental Health Act was passed, there have been a number of cases where people are now in prison—people who are dangerous to the community and dangerous to themselves, and who desperately need treatment? Is the Minister not being much too complacent in the Answer he gave to the noble Lord, Lord Broxbourne?

§ Lord Glenarthur
My Lords, I did not intend to be complacent at all. There are real difficulties associated with some of the more marginal cases. The noble Lord will be aware of that. I have not the figures he asked for, but I shall let him know what they are. So far as regional secure units are concerned, I hope he 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 regional secure units are now open, which will eventually provide a total of 264 places, of which about 120 are now staffed and available. Nearly 500 places are expected to be completed by the end of 1984, or early 1985, and 650 by the end of 1987. There are additional places in interim secure facilities and I shall be delighted to let the noble Lord have those figures, too.

§ Lord Avebury
My Lords, does the Minister recall that in the proceedings on the Mental Health (Amendment) Act, I pointed out that, as a result of the 899 more stringent requirements for the transfer of a person from prison to a special psychiatric hospital—in particular, the requirement that they had to be susceptible to treatment before such transfer could be approved—there would be in our prisons an increasing number of persons who were severely mentally disordered and for whom the prisons had no adequate provision? Is it not a scandal that in recent weeks there has been a succession of stories about self-mutilation by women in Holloway Prison? Is it not apparent that some kind of provision ought to be made outside the prison system for patients of this kind, even if they cannot be treated in special hospitals?

§ Lord Glenarthur
My Lords, we certainly hope that the implementation of Sections 35 and 36 of the 1983 Act, which has recently been introduced, will help to provide an alternative to remands in prison in cases where there is reason to believe that the person concerned may benefit from hospital treatment. But, meanwhile, both remand prisoners and sentenced prisoners may be transferred to hospital by the direction of my right honourable friend the Home Secretary under Sections 47 and 48 respectively of the Act. The success rate for recommendations from the prisons for the use of these powers is now very high, and we hope that this improvement will be continued.

Lord Winstanley
My Lords, apart from the question of the interests of these unfortunate people themselves, does the noble Lord agree that the presence in prisons of mentally disturbed offenders who ought really to be in secure units, or other institutions, places an intolerable burden on the shoulders of the prison officers, who are not trained or equipped to deal with people in those conditions?

§ Lord Glenarthur
My Lords, I would certainly agree that it places a burden. I have described the situation and the way in which the other sections of the Act are now coming into force, and, as I said to the noble Lord. Lord Avebury, those matters will assist the position.

§ Lord Ennals
My Lords, can the noble Lord say whether the Mental Health Act Commission is now looking at this disturbing situation? The noble Lord mentioned a number of sections of the Act. Can he say how many times use has been made of Section 39, which enables the court to find out what facilities exist in the 14 different regional health authorities?

§ Lord Glenarthur
My Lords, I cannot off the top of my head give the answer to the noble Lord's question about Section 39. Again, I shall find out and let him know the number of instances. So far as the Mental Health Act Commission is concerned, they have a wide remit and it is proper that they should look at this sort of thing; and that is what my noble friend Lord Colville and his commission will no doubt be considering.

§ Lord Broxbourne
My Lords, would my noble friend draw the attention of Ministers in another place to the concern expressed in this House on this sad and 900 sombre subject and urge them to take appropriate remedial action?

§ Lord Glenarthur
My Lords, my department's officials already have had discussions with senior officers of the National Health Service authorities, consultants, senior nursing staff from individual hospitals, directors of social services, and prison medical officers about the problem of what are known as "difficult to place" patients, who, in a sense, fall between two stools. This has been taking place generally, and ways of making required facilities available are being discussed. In this context they have been discussing, among other things, the position of the courts in making hospital orders.

§ Lord Kilmarnock
My Lords, I know that the noble Lord is always punctilious in writing to me. Will he confirm that he will write to me with the figures I have asked for and that he will place a copy in the Library, in accordance with the new procedure?

§ Lord Glenarthur
My Lords, I can confirm both of those points to the noble Lord.