HL Deb 10 June 1988 vol 497 cc1655-74

2.28 p.m.

Lord Harris of Greenwich rose to ask Her Majesty's Government what action they propose to take regarding mentally disturbed remand prisoners being kept in custody in police cells.

The noble Lord said: My Lords, just over three months ago I raised in the House the case of a mentally ill remand prisoner, Mr. Michael Flynn. Mr. Flynn had been remanded in police custody despite persistent efforts in the courts to have him sent to a mental hospital under Section 35 of the Mental Health Act 1983. Those efforts failed and, as we all know, shortly afterwards Mr. Flynn hanged himself in Brixton Prison.

I propose to return this afternoon to some of the issues raised in that debate. I do so partly because of what was said in the debate and also because of the recent opening of two temporary prisons run by the army. As a result of those developments, I hope that the noble Earl who is to reply to the debate will be able to tell us what progress the Government have been able to make in dealing with the deplorable situation in which mentally ill prisoners are held in small police cells in various parts of England and Wales and are denied the privileges obtained by mentally balanced remand prisoners who are held in prisons.

I should like to say a word about the privileges that they are denied as a result of being held in police custody rather than in prison department establishments. Of course they do not have the same visiting rights, as I am sure the noble Earl will agree. They do not have a member of a board of visitors to come round and talk to them and to be available for them to raise problems with. There is no governor whom they can ask to see. It is ludicrous to imagine that a chief constable, with all the other heavy responsibilities which he carries, can possibly take the place of the governor of a prison department establishment. The Chief Inspector of Prisons has no locus, as the noble Earl and his colleagues have confirmed on a number of occasions. There is, therefore, nobody at all supervising what is going on.

What I have to say at the outset will not, I suspect, come as a surprise to the noble Earl, because I should be astonished if he has not been told by chief officers of police what I am about to say. I have certainly been made aware of the anxiety of many senior police officers about the responsibilities which they are now being called upon to undertake. As the Minister knows, there is deep anxiety among many chief officers about the wider issue—which I do not propose to discuss today—of the use of cells in their police stations to hold Home Office remand prisoners. I believe that there are still over 900 such prisoners.

There is even more concern about the position of those who are mentally ill. A number of chief officers have told me in the most emphatic terms that their officers did not join the police service in order to become mental nurses. They do not have the training and they do not have the expertise to handle mentally ill prisoners for substantial periods of time. That is precisely what they are now being called upon to do.

I propose to illustrate the extent of the problem by referring to the cases of some of those sick people: the case of Mr. Garcia to which I referred briefly in the debate on 4th March; the case of Mr. Hollett and the case of Mr. Hector MacFarland. The noble Earl will be aware that I have given notice to his private office of those particular cases, which have also been the subject of Questions for Written Answer.

I turn now to the case of Mr. Garcia. I first heard about this man only just before the debate on 4th March. In the course of his speech on that occasion the noble Earl undertook to investigate the case. I am most grateful to him for having sent me an extremely frank letter setting out the details. This man, as the noble Earl has now confirmed, was held on remand for three months awaiting psychiatric reports. Mr. Garcia first appeared before Horseferry Road Magistrates' Court on 1st December last year. He was charged with police assault and the theft of property worth less than £16. The police assault case was subsequently withdrawn. Thereafter he was held exclusively on a charge alleging that he had stolen property worth less than £16. The reason he was so held was because everyone concerned realised that he was mentally ill, a problem made even more difficult because of his inablility to discuss his case intelligibly with his defending solicitor.

The court certainly did everything in its power to obtain a satisfactory psychiatric report on Mr. Garcia. It failed for two reasons. First, Mr. Garcia was being shuttled between one police station and another with periodic calls on prison department establishments. On two occasions he was held in cells at Highbury Corner Magistrates' Court. Twice he went to Brixton. He was then at Wood Street police station in the City of London, then at Cowley in Oxford; for 20 days he was held in a police cell in King's Lynn in Norfolk and finally he was held at Camberwell Magistrates' Court, subsequently being transferred to Brentford police station—all this on a charge of theft of property worth less then £16; and this went on for three months.

There was a second reason for the failure to secure a satisfactory disposal of this case under the Mental Health Act. In the letter to which I have already referred, the noble Earl informed me that the medical officer at Brixton, on a number of occasions between 4th December, when he first saw Mr. Garcia, and 4th January, when Mr. Garcia left Brixton on the final occasion, tried to arrange for a consultant psychiatrist at St. Luke's Hospital (which was the catchment area hospital) to go to Brixton to examine him. As the noble Earl confirmed, that hospital, I am afraid, did not comply with the request.

So between 4th January, when he left Brixton, and 1st March when the Horseferry Road magistrate eventually lost his patience over the way in which the authorities were handling this case and declined to remand Mr Garcia in custody yet again, this man who was charged with a trivial offence was held exclusively in police custody, this making it virtually impossible to have him properly examined by a consultant psychiatrist.

After reciting these events the noble Earl said in his letter that this must be totally unsatisfactory and he added: Of course the court should have been provided with the psychiatric report for which he was remanded. However, as you know, prison medical officers have no authority to compel National Health Service consultants to attend a prison to interview any patient".

That of course is entirely true, but, having recited those events, what precisely does the noble Earl, who has the ministerial responsibility, intend to do about the situation?

We are all aware of the hideous problems that face our underfinanced National Health Service, but it is plainly and incontrovertibly unacceptable that a sick man should be held in police cells for that length of time because a consultant psychiatrist finds it impossible to see him for a period of over a month. How many other men and women now in police cells are receiving the same wretched treatment as did Mr. Garcia? I suggest that immediate action must be taken by the noble Earl and his department to ensure that such persons held in custody receive urgent attention by our hospitals.

I very much hope that in the first instance the Minister will undertake to write to the Department of Health and Social Security drawing attention to this case, if the department is not already aware of it; and, secondly, that he will discuss its wider implications with Ministers in that department. If I may say so, I had a particular reason for saying "write to the department" and asking him to discuss this case with Ministers. Ministers sometimes use the phrase, "I shall draw this matter to the attention of my right honourable friend". Indeed, I have been guilty in the past of that same offence. They may do so by writing, but sometimes they do it by hoping that the right honourable friend regularly reads Hansard, which no doubt is sometimes the case but not always. I have chosen my language with particular care and I very much hope that the Minister will undertake to write to DHSS Ministers about the precise circumstances of this case and some of its wider implications.

I turn now to the case of Mr. Hector MacFarland. This man was held in custody for a period of nearly three months. The magistrates were so concerned about the manner in which this case had been handled that, as the noble Earl will be aware, they asked their clerk to write to the Home Office about it. Indeed, the noble Earl in a Written Answer confirmed that they had received such a letter and that the Home Office had replied to it. Mr. MacFarland was clearly ill when he first appeared at the South Western Magistrates' Court on 16th November. He was unrepresented and was remanded in custody for psychiatric reports.

Once again, we had the same wearisome routine: three stays at Brixton; eight stays in police cells; and all this for a man whom two psychiatrists said should be "sectioned". On four separate occasions at the South Western Magistrates' Court his papers were marked, "Must go to Brixton", but on each occasion he was sent to a police station. Why? Eventually, after nearly three months in custody Mr. MacFarland was finally, belatedly, admitted to Springfield Hospital. Again, I should be grateful to know what the noble Earl proposed to do to investigate the circumstances of this case.

I hope he will not say that matters of this kind are exclusively the responsibility of the police. In my view they are not. Remand prisoners are the responsibility of the Home Office, not of the police. Ultimately Ministers must be accountable to Parliament for what is going on and must not hide behind chief officers of police who have enormous responsibilities in other areas, as the noble Earl, who has responsibilities himself to the police, will be the first to confirm.

I now turn to the case of Mr. Winston Hollett. He was charged with threatening to kill a gas board official. At an early stage it became clear to everyone concerned that he was mentally ill. He was bailed to appear in court but did not do so. Subsequently he was arrested and appeared at the South Western Magistrates' Court in London on 5th April. He was then, understandably, remanded in custody. Then for a month this sick man, after two spells in Brixton, was moved from one police station to another on five separate occasions, once spending a week in Doncaster.

I should like to say two things about this case. First, in his letter to me of 27th April—a letter which was obviously drafted several days earlier, quite understandably—the noble Earl assured me that the aim was, to arrange for prisoners who are awaiting medical reports, if they cannot be immediately admitted to prison, to be held as close to London as possible". But this man was held for a week at Doncaster. Was that, to quote the Minister again, "as close to London as possible"? No doubt the noble Earl will have something to say about that.

The second issue to which I should like to draw the Minister's attention is the circumstances in which he was eventually admitted to a mental hospital, as he was. Fortunately for Mr. Hollett he had an exceptionally tenacious woman solicitor. On the fourth occasion on which he appeared in court following her strong representations the magistrates—who were clearly deeply troubled about the manner in which this case was being handled by the authorities—agreed to this exceptional course. Those of us who have experience in these matters will agree that it is undoubtedly an exceptional course of action. They agreed to bail him on condition that he accompanied her to the St. Thomas's clinic and remained in her custody until he was admitted to that clinic. So off she went with three police officers in a police van to the clinic.

After something of an argument, eventually the authorities there agreed to take him. This man was therefore admitted to a hospital entirely because he had an exceptionally vigorous and concerned solicitor. That is why he was subsequently admitted as a patient to St. Thomas's Hospital. If he had not had such a solicitor—if she had been overwhelmed with other cases; if that afternoon she had had two or three other cases before the same magistrates' court—Mr. Hollett would once again have been sent off to spend days or weeks in police cells in various parts of the country. I hope that the noble Earl will deal in some detail with the manner in which these cases were handled and with some of the wider issues involved.

I should like to ask the noble Earl two further specific questions. I understand from his letter to me dated 27th April that in February there were only 14 available prison places in Brixton Prison. However, on that same day 80 or more prisoners required those places. Is that still the position? I presume that because of the use of two army establishments, which has enabled the Home Office to transfer 700 or more men from local prisons, there are now more hospital places available. In that situation I hope that the noble Earl will be able to assure the House that it is now possible for him to guarantee that no longer will any prisoner with the kind of psychiatric problems which I have outlined be kept in custody in a police cell.

Secondly, I return to the case of Mr. Garcia who was not seen by a consultant psychiatrist for a month, despite the efforts of the medical officer at Brixton Prison, to raise his case and the general issue of mentally ill people remanded in custody with the DHSS. I do not want to be unfair to the DHSS but many consider that for many years even before the present Government's period of office the department has been shuffling off its responsibilities on to the shoulders of the Home Office. If it is determined to clear out large numbers of mental patients from the hospitals into what it is pleased to describe as "treatment in the community", in the certain knowledge that the resources for such treatment are scandalously inadequate, it should at least be asked to give an assurance that when consultants are asked to examine mentally ill patients in prison department custody such requests will be given absolute priority. Will the Minister ask his right honourable friend to give such an undertaking?

I very much hope that the noble Earl will be prepared to give clear, positive answers to those questions. In his letter to me regarding the case of Mr. Garcia, the noble Earl said: This was a particularly serious example of the kind of thing which can go sadly wrong when the system is operating under heavy pressure".

I believe that it is idle to imagine that Mr. Garcia's is an isolated case. The other examples that I have given this afternoon demonstrate that that is clearly not so. I believe that today we expect from the noble Earl an unequivocal assurance that urgent action is now being taken to deal with the situation in which many sad, confused, sick men are being treated in a manner which is a reproach to our society and which is creating justifiable indignation in our criminal justice system.

2.49 p.m.

The Earl of Longford

My Lords, we should all be grateful to the noble Lord, Lord Harris, for raising the Question so cogently this afternoon, following his arresting speech on 4th March. I believe that all noble Lords can agree that in the whole field of social problems there is none more pithy—if that is the right word—than the question of mental offenders. I ventured to say that in a debate which I raised on the subject a little while ago. We punish offenders, delinquents and criminals. In my opinion we do not punish them very constructively but we have this idea, accepted throughout society, of punishing them.

I am bound to say in passing that I am very sorry that the Home Secretary, to whom I have paid tribute more than once in this House, should now apparently be intending to use his powers in order to keep some people who are already serving long sentences in prison for a still longer period. We understand the pressures under which he is working when he is working for a Prime Minister who is devoted to hanging, but I am still sorry that the Home Secretary should have stooped to that. However, that is all by the way.

When it comes to sick people, we do not punish them; we try to treat them. However, when we have mental offenders—people who have broken the law but are apparently sick as far as we can judge—we find ourselves in a grey area. With all the resources in the world, I do not believe that any of us could claim to know exactly how those people should be treated and we do not have all the resources in the world. Many of us believe that the Government should be devoting more resources to this problem but whether the resources are great or small it is a very difficult problem. Whether there be one or a thousand mental offenders, I do not want to pretend to claim that anybody could come up with a slick answer.

I shall not speak for long and I shall try to look at this problem raised by the noble Lord, Lord Harris, through two pairs of eyes—through a mother's eyes and a chief inspector's eyes—both the mother and the chief inspector trying to do their duty. A mother brought her son to see me at the end of last week. He was a nice-looking young man, just over 20 years of age. He would be perfectly presentable if he came to visit the House. In fact he could be here this afternoon but I do not believe that he is. There is nothing whatever wrong with his appearance. I am told that, when well, he is quite a happy person, amusing and so on. However, when his mother brought him to see me last Thursday he was incapable of speech. I do not believe that a single word was extracted from him during our conversation. That is the state to which he has been reduced. It is an open question as to why he should find himself in that situation but that is how he is.

I have mentioned the case to the noble Earl but I am not expecting him to reply to it in detail. I am simply taking this as an example of the problem and not bringing it before the Government as an official complaint. It may or may not come before them in some other way. Here was a young man who was in a state of coma when he came to see me although on the whole he has led a normal life until he reached the age of about 20. According to his mother and other people who know him, about five years ago he was beaten up in a police cell. I do not ask the noble Earl to accept that version today but he certainly suffered injuries which his mother saw at that time after he had been apparently knocked about. I have no idea what the excuse was for knocking him about.

Since that time he has been in police custody several times but never for serious offences. About two or three years ago he developed epilepsy; there is no doubt about that. That is a medical fact. It can well be said that that was a result of being beaten up in a police cell. It may be said that he would have developed epilepsy anyway; I have no means of judging that. However, he has developed epilepsy. From that time until now when he has been in custody those concerned with him have shown themselves totally unable to deal with him. He is an epileptic who has broken the law or is said to have broken the law—because there is some argument about that—but there could be a distinct problem. The fact is, his epilepsy seems to be worse, so that now, although he did not have a fit when I saw him, he has been reduced to a state of being in a walking coma.

Mr. Peter Thompson, who I have said on previous occasions, and will say again, has done more for mental health through the Matthew Trust than any layman known to me, in recent years has raised the case of this young man with Ministers, as I mentioned in advance to the noble Earl. It was in November 1986 that Mr. Douglas Hurd, the Home Secretary, wrote to Mr. Thompson: I understand that you discussed [the easel with Dr. John Kilgour, Director of the Prison Medical Services, at a meeting on 5th November and that the general points you made in your letter to me were also raised. I do not think that I can add anything to what was obviously a most useful and frank discussion. From that we can say that this issue was taken seriously by the Home Secretary and the chief of the medical services. Mr. Hurd's letter continued: I have, however, sent a copy of your letter to the Lord Chancellor's Department and asked them to reply". The noble and learned Lord, Lord Hailsham, then Lord Chancellor, wrote a long kindly reply, but it concluded with this passage: Whether or not a transfer to hospital under Section 47 of the Mental Health Act is the appropriate one in his case is a matter entirely for the Home Secretary. Naturally, I am unable to predict the outcome of any such application. So the ball was played backwards and forwards between the two of them. At any rate, with the best will in the world those two eminent gentlemen were unable to do anything useful.

The young man is now awaiting a brain scan which may help to decide whether he has suffered permanent brain damage as a result of a blow or blows on the head. I do not predict the outcome of that brain scan. I leave his case there for the moment. I am certainly not asking the Minister to admit that there has been failure on the part of any of his officers. Personally, I think there has been, but today I am concerned with the wider issue. I merely give that example as an illustration of what happens to someone who is now admittedly mentally disturbed.

Let us leave out of our discussion the responsibility for the original injury—the blow which must have occurred. How can we make sure that epileptics and all others with mental troubles of one kind or another are looked after with any degree of humanity or efficiency in police cells? It may be said that if they are transferred immediately to prison and, it is to be hoped, to the prison hospital, even there it will be difficult to know exactly what should be done. However, if they are transferred to the prison hospital at Brixton, which I have visited frequently, they will be dealt with by doctors who have some psychiatric training. I understand that in police cells that would be extremely unlikely.

I said that I would look at this matter from two perspectives—through two pairs of eyes. The mother has told me her tale, which I believe, but it is a mother's story. I now look at the matter from the perspective of the chief inspector of a large holding unit not 100 miles from here which I visited this week. We must put ourselves in his position. Two hundred prisoners a day come in from the courts. Somehow or other, before nightfall they have to be found accommodation for the night. There is hardly any accommodation in the holding unit.

When I visited the unit it had on its books over 400 remand prisoners whom the courts intended to go to Brixton but for whom Brixton has no accommodation. I am not seeking to derogate from the force of what was said by the noble Lord, Lord Harris, but to the argument that they should go to Brixton, and yet do not, the answer is that there is no room in Brixton. That is the situation. As regards the chief inspector, the answer is that at Brixton there is no joy. The holding unit has to find such accommodation as it can in the police cells of London. When that accommodation resource fails, which it does habitually, it must scour the country to discover where the remand prisoners can be placed and very often they can be placed only in extremely remote places.

However, we should not blame the police for this situation because it is one in which the police find themselves when the remand prisoners come from the courts. There may be some difference of opinion as to whether it is possible, in the rush and bustle of these 200 arrivals, to identify those who are mentally disturbed. I believe that to be hardly possible. There are two doctors, one of whom is permanent and the other attached. The permanent doctor, who is a general practitioner, told me that there was usually sufficient information to decide which of his daily intake are mentally disturbed.

I was introduced this week to two remand prisoners who were alleged to be disturbed. One was a former solicitor who had fallen on evil days and the other was a gentleman who had no desire whatever to shake hands or to talk with me, which, I suppose, some people would consider a kind of good sense. However, that struck me as a sign of mental disturbance.

Lord Mishcon

My Lords, that is very subjective.

The Earl of Longford

My Lords, the doctor told me that in his opinion the real problem was what to do with the prisoners after they had been identified as mentally disturbed. In the opinion of the doctor who examined this man, there was a total shortage of accommodation for remand prisoners in general and obviously for remand prisoners who were likely to suffer much more than the ordinary prisoners who are being pushed around in this manner. Taking a broad picture, we should have much more accommodation.

I did not prepare my final remarks until I heard the noble Lord, Lord Harris. There was a phrase that he used that struck me most forcibly. He said that there must be urgent treatment for those who have been identified as mentally disturbed. That is the key point. When such people are identified there should be urgent treatment. However, what happens is that they are sent off to police cells in London or it may be much further afield. I have a question to put to the noble Earl but I do not believe that he will be able to answer me. Mentally disturbed people are identified as such from the holding unit and they are sent to the police cells. Can the noble Earl tell us whether they are given urgent attention? If he can answer that question I shall be surprised.

I put that question forward from the point of view of the Matthew Trust, which has asked me to indicate that it feels strongly about this matter. The trust feels that as doctors are not available generally when prisoners arrive at the police cells, someone in the police station should be sufficiently trained to say that a person is mentally disturbed and needs urgent attention. I am raising the problem, but the obvious solution is the provision of much more accommodation. The short-term solution is to make sure that in the police stations there is someone, whether a police officer or a doctor, who can identify these people and then put in an urgent plea to the effect that such people require top priority and urgent attention, which the noble Lord. Lord Harris, demanded.

I put this question to the noble Earl: taking London as an example, if a mentally disturbed person arrives in a police cell, what are the prospects of his receiving any expert attention and how soon can he expect to receive it? I support the general tenor of what the noble Lord, Lord Harris, said and I am sure that I shall support the noble Lord, Lord Mishcon, when it is his turn to speak.

3.5 p.m.

Baroness Faithfull

My Lords, I am grateful to the noble Lord, Lord Harris of Greenwich, for bringing forward this matter today. I am grateful for two reasons; first, because of the problem itself; and secondly, because on the last occasion I saw the late Lord Butler of Saffron Walden before he died, he said to me, "When will they implement my report?" That was a long time ago and the report has not been implemented. I have a deep feeling of sympathy both for prison officers and for the police. We are asking prison officers and the police to do a job for which they are not trained, in which they are not experienced and which is not their job. We should not ask them to look after the mentally disturbed and mentally ill prisoners, whether on remand or in prison.

I wonder whether the noble Lord, Lord Harris of Greenwich, will forgive me if I widen the debate. I wish that on occasions it were possible to have two Ministers at the Dispatch Box at the same time. I should like to have seen Ministers from the Department of Health and Social Security and from the Home Office. While remand prisoners at police stations are the direct responsibility of the Home Office, nevertheless I believe that this a joint problem shared between the Department of Health and Social Security and the Home Office. The Home Office cannot deal with it alone, and I am not at all sure that it is right that the Home Office should deal with it alone.

There is no strategy between the two departments in handling mentally disturbed and mentally ill patients. Until we have a strategy we shall continue to have the problems we have now. It will not be solely the responsibility and fault of the Home Office, the police or the prison service. In order to have a strategy one has to have knowledge. In order to gain that knowledge one needs to undertake a great deal of research into the Mental Health Acts and the criminal justice system. Until those are linked together we shall never have a sensible policy for prisoners on remand, either in police cells or in prison.

The noble Lord, Lord Harris, referred to care in the community. How many mental patients have been dischared from mental hospitals because of this wonderful concept of care in the community? It is a wonderful concept but at the moment it is a poor concept because it is not being properly carried out. I know of a mental hospital that closed down with a proportion of the patients—I am not saying all—being discharged. They did not have an address to go to; they did not have social workers or doctors in charge of their cases. They were dispersed from the mental hospital right along the South coast. They had money in the form of income support and they were given clothes. The landladies took them in because they saw these nice respectable gentlemen and only realised, perhaps a week or so later, that they had mental patients in their hoarding houses.

Not one of those patients had a social worker or a doctor assigned to his case. They were not planned discharges. If mental hospitals are to discharge patients into the community, there must be planned accommodation, planned treatment and social workers to take charge of their cases. Care in the community for patients cannot succeed unless there is a plan for every patient who is discharged. Therefore I should have liked research carried out to determine how many patients discharged from mental hospitals have found their way into prison or police cells. I do not believe that this is the fault of the Home Office; I believe it is the fault of our mental health system under the Mental Health Acts.

It is always an invidious task to put people into categories, but I think I must do so for the purposes of the debate. I speak of the mentally ill. Doctors will accept the mentally ill into hospital because they are mentally ill and can be treated. However, if one asks a psychiatrist or a consultant to look after a mentally-ill patient who cannot be treated, he will say that it is not a case for the hospital. Well, in those circumstances, who is it a case for? Further, what happens to those patients? Such patients come out into the community and, in fairness to my own profession, the social workers do their best to deal with them against fearful odds.

Then we have the mentally handicapped. Those people, whether fairly normal or ill, cannot survive in the community without help. As the noble Lord, Lord Harris of Greenwich, said, many of them find themselves in police cells or in prison.

Therefore, I think that there ought to be a joint review between the two departments; namely, the Department of Health and Social Security and the Home Office. One department cannot do it without the other. Until a joint committee is set up for both departments to look at the situation, we shall continue to have the problems that the late Lord Butler of Saffron Walden found; problems that we have today and upon which we have made no progress.

I turn now to my second point; that is, the issue of facilities. One year, when I was working as a director of social services, old Joe came in to see me two days before Christmas. He came in every Christmas. He came in and said, "I want to wish you a happy Christmas". I said, "But Joe, it's not Christmas yet. We have two more days to go". He then said, "No, I have business to do". Of course I never wonderd what the business was, I merely thought that he was getting ready for Christmas.

However, that night I opened my newspaper and saw that a policeman had been assaulted and badly injured. Old Joe was responsible and he had been put in a police cell. I went round to see him and said, "What on earth did you do that for?" He said, "Well, I have to have somewhere for Christmas, don't I?" In fact I looked up his record and found that every Christmas he bashed a policeman. Nevertheless, because the police and the prison service were so generous they put him in prison each Christmas where he could have a good Christmas dinner.

However, worse was yet to come. On this particular Christmas I was sent for by the prison governor as old Joe was making a frightful row in the prison because he had not been given his usual cell. Of course I was appalled by all of this. So, subsequently, a group of us joined together and we have now opened—although it took some time—a Simon Community, a Richmond Fellowship house and a Church Army hostel. Needless to say since that time we have never had any trouble with old Joe, or any of his compatriots, because we have had the facilities to offer such people. Old Joe was mentally handicapped; he was also mildly mentally ill.

I should like to follow the noble Lord, Lord Harris of Greenwich, and mention another similar case. I knew a girl who flung a brick into the window of a Marks & Spencer shop and cracked it from top to bottom. I begged the police not to take her into a police cell and in fact I cared for her in one of our children's homes. However, she escaped—having already attempted suicide—and I sat with her in the dock of the court. It was said in court that she must go to prison merely because there was no place in any mental hospital for her. I stood up in the dock and begged the judge not to allow that to happen.

The judge adjourned the court and himself rang up the then Home Secretary, who in turn got hold of the Secretary of State for Health and Social Services, and that girl went to Rampton. If it had not been that judge, and if I had not stood in the dock with the girl, and absolutely refused to give her up unless she went somewhere else, she would have gone into a cell. I suggest that she would have committed suicide because she had already attempted to do so on two or three occasions. She was in Rampton for many, many years. I visited her frequently.

I therefore come to my final points. One is that we need a strategy. To have a strategy, there must he research, jointly, by the Department of Health and Social Security and the Home Office. Secondly, we must have facilities and resources in the community—hospitals and small homes. Lastly, we must not discharge patients from mental hospitals unless it is on a planned basis and they have the facilities, the wherewithal and the help to enable them to live in society without going to prison and into police cells.

3.16 p.m.

Lord Mishcon

My Lords, the House will be grateful, and not for the first time, to the noble Lord, Lord Harris of Greenwich, for raising a serious matter with regard to our prisons. If he will allow me to say so, we have been jointly concerned about the figures for remand prisoners in police cells. I raised that question in the House only a couple of days ago by way of a supplementary question to the Home Office Minister who was then, if I may use the phrase, on duty. I asked whether the Home Office had any programme date by which the target would be reached of no more remand prisoners in police cells.

The junior Minister replied with his usual courtesy, but said that it was not possible for such a date to be given. He was kind enough to say that the remarks that had been made on that occasion would be communicated to his right honourable friend.

Today, we are dealing with part of that issue, and it is a serious one; namely, those who are mentally disturbed and who find themselves in police cells. It is not only a question of those who have not been convicted. We are dealing today with the narrower, and it may be more human, issue—the other issue is a human one as well—of those who are on remand and have not been convicted and who are thought to be mentally disturbed.

The noble Lord, Lord Harris of Greenwich, dealt, I thought to great effect, with four cases that he brought to the attention of the House; one of them—that of Flynn—with which we were jointly associated. It was the very first case and a very tragic one.

It may help if the House realises the extent of the problem. The research that I have done shows that the Question was raised in another place as recently as December 1987. It was a Question that was asked by Mr. Holland of the Minister, Mr. John Patten. It was one that required and obtained a Written Answer. The question was: To ask the Secretary of State for the Home Department how many people currently being held on remand in police cells (a) nationally and (b) in London, require psychiatric assessment or treatment; and if he will make a statement". This was the reply of the Minister, a matter of six months ago: On the night of 6/7 December—the most recent date for which information is available—51 remand prisoners awaiting state of health or psychiatric reports were held in police cells in England and Wales. All were awaiting transfer to Brixton Prison. Thirty-five were held in London and 16 elsewhere. Information on prisoners requiring psychiatric treatment is not held centrally and could be obtained only at disproportionate cost".—[Official Report, Commons, 14/12/87; col. 345.] The House will realise that this is not—the noble Lord, Lord Harris, in his presentation never suggested that it was—a matter of having just four, five or six cases at any one time with which we are dealing. It would be interesting to know whether the Minister happens to have the figures available; but frankly I confess that I did not give him notice of this question. It is very pertinent to note that at a recent date there were 51 remand prisoners awaiting examination in prison cells because it was thought that they might need psychiatric treatment.

I shall now follow the line that was taken by the noble Baroness, Lady Faithfull. I ask: if we are really to deal with this problem and know statistically the problem with which we are dealing, both at the Home Office and the health service level, why is it that there are no nationally prepared figures available for those who are actually found to be in need of psychiatric treatment? If we are to deal with this problem, how odd that those figures are not being compiled and how necessary, if I may respectfully suggest this to the Minister, it is that there should be such statistics.

This matter has not been mentioned so far, but I have no doubt that the noble Earl will draw our attention to it. There was an interdepartmental committee set up only a year ago. It reported. It was the interdepartmental working group of Home Office and DHSS officials on mentally disturbed offenders in the prison system in England and Wales. That is a rather pertinent matter and I have taken the trouble to read the report. All that I shall do—I hope not at length—is to try to trace a logical series of mental reasoning, if you like, as to where we have reached today.

I wish the House to know that the Government announced that they accepted all the 16 recommendations of this interdepartmental working group in May 1987. If I may ask the Minister to do so, it would be interesting if he indicated, since this interdepartmental committee reported exactly a year ago, how many of those 16 recommendations have been implemented and what is happening to the rest of them.

Let us start on the logical line with page 3 of the report and what is said at paragraph 3.5. I need read only one sentence: Government has a responsibility to mentally disturbed offenders to ensure that they receive appropriate care and management, and treatment where that is indicated, whether that falls to be provided in the prison system or elsewhere". I pass from there to page 29 of the report, all of which, as I said, has been accepted by the Government. I shall read very briefly from the background note on page 29, which states: Mentally ill patients normally need to be held in establishments with hospital officer night cover to provide the necessary degree of observation". It is completely obvious that no such provision is made or can practically be made in police cells. Following upon that, I turn to page 10 of the accepted report where one reads:

"Remand and Short Sentence Prisoners

5.7 The censuses and research study concentrate on sentenced inmates … There remains unexplored the extent and nature of mental abnormality that falls short of the provisions of the MHA amongst the remand population and (until the research study is completed) those serving short sentences, which will include a number of 'skid row' personalities".

Following, if I may, the words of the noble Baroness, Lady Faithfull, I ask whether that research was carried out; whether it is being carried out; and if not, in the famous following words, why not? I end my quotations from this report by referring to page 22 and conclusion 8.6, which states: There is a need for (and there is scope for) improved co-ordination between penal and health and social services". That was the final recommendation of the report. That is the whole central theme of this debate. I follow the noble Baroness, Lady Faithfull, but not in her recommendation that there should be only the research and the inquiry. Some part of that may have been met by the setting up of this interdepartmental committee between the two government departments. I assure the noble Baroness that I was going to make this recommendation before I had the pleasure of hearing her speak, but she has given me the courage to make it with more emphasis than I otherwise should have done.

I see no reason why, as a result of this debate and the serious nature of the matters to which the attention of the House has been called, there should not be set up a completely running committee consisting of representatives of the police, the prison service and the DHSS to tackle this problem until it is dealt with satisfactorily and in a civilised way.

3.28 p.m.

The Minister of State, Home Office (Earl Ferrers)

My Lords, on a Friday afternoon, which is not always a well attended afternoon, we have had a debate of great importance. If I may say so without being platitudinous, it has been a debate of considerable humanity. The noble Lord, Lord Harris of Greenwich, who put down this Question, made some characteristically trenchant and forceful points in what I thought was an important speech.

He raised many points of detail on matters of great importance to a small area of our life which must not go unforgotten. The concern of the noble Lord, Lord Harris, for the circumstances of mentally disturbed prisoners in police cells is well known. It is right that he should continue to press the Government on these matters because they are important. I was grateful to my noble friend Lady Faithfull when she said that she wished there were two Ministers on the Front Bench to reply to this Question. I too should have been happy to see that situation. However, as my noble friend will know only too well, Ministers answer on behalf of the Government and not on behalf of a department. Perhaps she will be good enough to bear with me and with the inadequacies not only of my own department but of another department over which I have no direct responsibility.

The Question which your Lordships face today deals with one of the effects of prison overcrowding.

Every day the courts in London commit some 400 people into custody. Every day between 30 and 40 of those people are remanded for the purpose of obtaining medical or psychiatric reports. One must remember that not all of those who are remanded for a psychiatric report will prove to be mentally disturbed people. The purpose of the report is not just to find out whether they are mentally disturbed—although that is of course important—but also to assist the court in determining the case.

A minority of those 30 to 40 prisoners remanded in London cannot be admitted to prison hospitals. As a result, they have to spend some time in police custody. The noble Lord, Lord Mishcon, asked how many people were being held in police custody. On 31st May, there were 43 people held in police cells. By 8th June, that number was reduced to 28. That is a bad state of affairs, which we should not wish to see exist. The encouraging part is that the number of those in police cells who were awaiting medical or psychiatric reports on 31st May is 50 per cent. less than it was when we last debated the matter on a Question which was put down by the noble Lord, Lord Harris of Greenwich, on 4th March. The figure of 28 for 8th June means that the percentage is even higher.

The situation has improved and it is still improving. However, the figure of 28 people in police cells must be seen in the context of the 2,000 or more prisoners who are committed for psychiatric reports each year to Brixton Prison, and of the situation in which that prison was holding 50 per cent. more prisoners than it was designed to hold. All of that represents a major burden to the police force, to which the noble Lord, Lord Harris, rightly referred. Ill-equipped as it is for the task, it manages with the kind of resourcefulness and adaptability for which we have come to respect it.

However, the noble Lord, Lord Harris, and my noble friend Lady Faithfull were quite correct to say that people join the police force to become police officers and not to become prison officers. It is a situation which we do not like to see. It remains our aim to get all prisoners out of police cells as soon as we can possibly manage it. We have opened two temporary prisons, to which the noble Lord, Lord Harris, referred, to help to do just that. As a result, the total number of prisoners in police cells has been reduced from 1,575 at its peak on 8th March to just over 800 today.

That is the background to the problem. We must see the facts as they are. We are bound to see, though we may not like it, the existence of an undesirably high number of prisoners in police cells for the time being. There is simply nowhere else to put them. However, we are making significant improvements, particularly in regard to the situation of prisoners who are remanded for medical or psychiatric reports.

The question which the noble Lords, Lord Harris and Lord Mishcon, have asked, and which is in the back of all our minds, is, "Are we doing all that we can to get psychiatric cases into prison hospitals?". I use that term as shorthand, to mean those who are remanded for psychiatric reports and others who appear to be in some way mentally disordered. The police have an established policy of making every effort to place such people into prison as quickly as possible. They are given a high priority for prison places, as and when those places become available.

Obviously, it is easier to take advantage of available places in Brixton Prison if the priority cases are held in, or near, London. Unfortunately, it is not possible to ensure that every psychiatric case is held in London or in the Home Counties, although the majority now are. And this is a further improvement which has taken place since the last debate initiated by the noble Lord, Lord Harris, on this subject.

The Earl of Longford

My Lords, may I ask the noble Earl how that priority works? The noble Earl says there is a system of priority and I am sure, therefore, that there must be. However, there are no signs of it. Does it work from the holding unit here, from police cells, or Brixton? I have no impression myself of the operation of any system for giving priority to psychiatric cases in Brixton.

Earl Ferrers

My Lords, I shall come to the point when I answer the noble Earl's original question. When people are sent to police cells they are inspected and given medical attention where that is considered appropriate. It is after medical attention has been given that the decision about priority has to be taken.

The noble Lord, Lord Harris, referred to Mr. Hollett, who was in Doncaster. The noble Lord asked whether I thought that Doncaster was close to London. As he will appreciate, I said that it was the aim of the Metropolitan Police to arrange for prisoners awaiting reports to be held as close as possible to London. Unfortunately, given the complexity of the situation, it is not possible to achieve that objective in all cases. It was not possible in Mr. Hollett's case. It is not always possible now, but matters are improving in that respect.

Cell space in London continues to be limited, and much of it has to be used for prisoners who are in transit, otherwise the whole complex logistical system would grind to a halt. The overriding factor is, of course, the availability of space in prison hospitals. The resources of Brixton Prison are finite. Inevitably, that constitutes a constraint. But the situation is improving. In recent weeks, it has generally been possible to find a place at Brixton for all urgent cases shortly after they have been identified a such.

The noble Lord, Lord Harris, referred to Mr. MacFarland and asked why he was not admitted to Brixton. Regrettably, it was not possible for the police to comply with the court's wish that Mr. MacFarland be admitted to Brixton because there were no available places at Brixton at the time in question. Since then the situation has improved and urgent cases can be found a place at Brixton quickly, usually—and I hope that this will satisfy the noble Earl, Lord Longford—within about 24 hours.

We also hope that "Fresh Start", which began operating at Wandsworth Prison only this week, will help alleviate the problem. The lifting of restrictions on admissions by the Prison Officers' Association is also a very welcome move. We hope shortly to see the Wandsworth Prison hospital beginning to relieve Brixton Prison hospital of many of its convicted medical cases. That will enable Brixton to take more unconvicted medical cases.

A further benefit of the ending of industrial action at Wandsworth Prison will be to relieve Brixton of some of its overcrowding, which in turn will enable the Governor of Brixton to devote more of the accommodation at that prison to medical use. Plans are also well advanced for the hospital at Pentonville to accept transfers from Brixton whenever possible. That, too, will help.

The prison medical service is at present undertaking an urgent review of the existing population in the Brixton hospital in order to identify possible candidates for transfer to those other hospitals. That process will not end when the first batch of prisoners is transferred. It is intended that reviews will be undertaken on a regular basis—at least weekly—in order to secure the greatest possible transfer of medical cases from Brixton.

I hope that these measures relating to prison hospitals which I have described and which will be complemented by the continuing efforts of the police to ensure that psychiatric cases are accorded priority treatment will continue to improve the present position. But we cannot relax our efforts. As long as significant numbers of psychiatric cases remain in police cells, we have to do whatever we can for them. The police take all possible care in dealing with such cases.

The noble Earl, Lord Longford, was especially concerned about what happens to these people from a medical point of view. All prisoners are medically examined on arrival from the courts. While they are in police cells, police surgeons are called in whenever necessary and the police act on their advice in each case. The general instructions to the police are clear. The police will request the attendance of a police surgeon when a prisoner in their care appears to be suffering from any medical or psychiatric symptoms which require urgent treatment. A police surgeon is also called in to a police station if a prisoner requests medical examination.

The police are alert to prisoners who display bizarre behaviour or signs of distress, and will contact a police surgeon or take the prisoner to a hospital if necessary. As I have said, all prisoners are medically examined on arrival from the courts. The police will call upon the services of police surgeons whenever necessary, and in each case will act upon their advice.

The noble Earl, Lord Longford, asked how long prisoners will have to wait. I am bound to tell him that those who are identified as being seriously mentally disturbed are given a high priority for transfer to prison. From the point of view of medical assistance they will receive the same treatment as do other patients under the National Health Service. If a prisoner's condition deteriorates, urgent action will be taken to secure the first available place in a prison hospital. That is arranged through the well established channels of liaison between the police and the prison service.

In addition to these procedures, the Metropolitan Police and the prison medical service have worked together so that certain London police station cells are set aside for psychiatric cases. Medical officers from Brixton Prison visit these cells in order to examine the prisoners. Where it is possible, the visiting medical officers produce reports as a result of those examinations. That avoids the need for those cases to wait for places at Brixton in order to undergo examinations and for the reports to be made. The reports which I have received from the police and the prison service show that this system is working well.

The noble Lord, Lord Harris, drew attention to a number of specific instances in which it appears to have taken a long time for the prison service to provide the necessary reports to the courts. It is a fact that the Government devote considerable effort to reducing delay in the criminal justice system. But we must recognise that the provisions which empower the courts to commit people compulsorily to a psychiatric hospital for treatment are also designed to protect the right of the individual. That is why the law provides that the court first must have received medical evidence as to the appropriateness of that course, and then must be assured that a hospital place is available.

These procedures inevitably take time. Unlike a patient who is in an ordinary hospital or who is in one which is administered by the prison medical service, a person who is compulsorily detained in a psychiatric hospital under the provisions of the Mental Health Act 1983 may be given treatment without his consent.

The recent cases of delay to which the noble Lord, Lord Harris, had drawn attention emphasise the importance, in suitable instances, of the mentally disturbed, the feeble-minded or the inadequate being channelled into the health or social services system rather than the prison system. My noble friend Lady Faithfull made an enormously helpful contribution, with her vast experience of the problems of social workers and those who are disturbed.

The Mental Health Act 1983 provides for the transferring out of the prison system into the social services system of those who are mentally disordered. This aspect of the work of the Act featured in the report of the committee to which the noble Lord, Lord Mishcon, quite rightly drew attention. It is the report of the Inter-Departmental Working Group of Officials on Mentally Disturbed Offenders in the prison system. Discussions within and between the Home Office and the Department of Health continue in order to channel the mentally disordered away from the prison system.

I should like to give my noble friend Lady Faithfull, and the noble Lord, Lord Mishcon, who referred to this matter, this assurance. It is a matter of very considerable concern. We are having conversations between the two departments in order to try to see whether there are ways in which this can operate better.

The Flynn case, to which the noble Lord, Lord Harris, referred, raised questions about the adequacy of procedures for obtaining a medical report on a prisoner of no fixed abode. My officials in the Directorate of Prison Medical Services have written to the Department of Health and Social Security seeking further information about the guidance which is given to NHS consultants in such cases. Once they have responded, we shall be better placed to decide whether any amendment or clarification may be needed.

The delay in obtaining psychiatric assessment in the case of Mr. Garcia was also obviously unsatisfactory. The noble Lord, Lord Harris, expressed that concern most forcefully. As I explained in my letter of 27th April to the noble Lord, prison medical officers have no authority to compel NHS consultants to attend a prison in order to interview any patient. But, as a general rule, the prison medical officers receive ready help from their NHS colleagues. However, there are occasions when the arrangements for the consultant's visit break down. The noble Lord, Lord Harris, mentioned a number of these cases. I think it is right to say that when a breakdown occurs it is not always the fault of the consultant. Indeed, it may not be anybody's fault.

One factor which may delay matters is that not just any consultant will do. Before it makes an order that a hospital place is available, the court has to satisfy itself that the consultant chosen will be able to offer a bed in a hospital within the appropriate catchment area. That may not be the area in which the court or the prison itself was located. It may be a quite different part of the country from that where the prisoner or his family live. Where the prisoner is of no fixed abode, identification of the right catchment area, and therefore of the appropriate hospital and consultant, can be difficult. It can be a time-consuming process. I share the concern which the noble Lord, Lord Harris, expressed about the delays which can occur in getting these patients the psychiatric attention which they need. That is an expression of concern which has appeared from all parts of the House and from all noble Lords who have contributed this afternoon.

The Home Office officials are in touch with officials in the DHSS on the issues which arise from the Garcia case and others. We shall continue to do our utmost to ensure that prisoners and consultants are mutually accessible.

My noble friend Lady Faithfull referred to the treatment of the mentally ill and the mentally handicapped. The interdepartmental working group considered the interface between the criminal justice and health and social services systems. The various facets of the problems continue to receive attention in discussions between the Home Office and the DHSS. I realise the force with which my noble friend has made her points this afternoon. I shall ensure that they are noted, in the same way as I shall ensure that all your Lordships' remarks are noted.

The noble Lord, Lord Harris of Greenwich, said that when he stood at this Dispatch Box he used the time-honoured expression that he would draw the point to the attention of his right honourable friend. He was slightly sceptical as to whether his right honourable friend ever received the points which the noble Lord indicated he would draw to his attention. I shall give the noble Lord, Lord Harris, the assurance that I shall write to my right honourable friend the Minister for Health to draw to his attention the concern which has been expressed not only by him but also by the noble Lord, Lord Mishcon, the noble Earl, Lord Longford, and my noble friend Lady Faithfull. This is an important matter.

With regard to the general problem of mentally disturbed prisoners in police cells, I can assure your Lordships that we are not satisfied with the conditions that exist at the moment. They have improved considerably and we are hoping to improve them further.

Lord Mishcon

My Lords, before the noble Earl sits down and leaves for a restful weekend, I should like to ask him to refer to the suggestion that I ventured to make. I suggested that in view of the urgency of the problem—and there is no doubt that discussions are taking place but, as we know, they often consist of a game of ping-pong between departments—would it not be worth at least considering my suggestion that a committee should be set up consisting of representatives of the police, the prison service and the DHSS until the situation is, we hope, dealt with. Obviously I do not ask for the Misnister's assurance that such a committee will be set up; I merely ask that the suggestion should be seriously considered.

Lord Harris of Greenwich

My Lords, before the noble Earl leaves to enjoy his weekend, as we hope he will, I should like to support what was said by the noble Lord, Lord Mishcon. I believe that there would be strong support among many senior police officers for such a committee. I hope that the Minister and his right honourable friend will consider the matter seriously.

Earl Ferrers

My Lords, I should like to apologise to the noble Lord, Lord Mishcon, for not having referred to his important suggestion. One of the drawbacks of the noble Lord speaking in the position that he does, immediately in advance of myself, is that sometimes I find it impossible to write appropriate notes of all that the noble Lord says. I try to write some notes but I omitted that particularly important point. Of course I shall consider the suggestion and I shall ensure that the problem which the noble Lord has identified is given consideration. It would be unwise of me to say at this moment what the result will be but I shall ensure that the matter is considered.

House adjourned at seven minutes before four o'clock.