Prisoners (Mental Health)

HC Deb 17 March 2004 vol 419 cc103-24WH

2 pm

Mrs. Annette L. Brooke (Mid-Dorset and North Poole) (LD)

We are here to discuss an important subject this afternoon, notwithstanding the alternative attractions: some people are listening to the speeches on the Budget, and others are talking to the media. I particularly wanted to have this discussion following the annual report of Her Majesty's chief inspector of prisons for England and Wales for 2002–03. I tabled an early-day motion earlier this year welcoming the report, but also calling for an urgent review of how those with mental illnesses are treated.

Hon. Members will almost certainly have witnessed the sad results of girls self-harming in prison, and I have a tragic memory of visiting the special unit in Feltham young offenders institution for young men with severe mental health conditions. The dedication of the staff was impressive, but that memory stays with me. Prison suicides currently average two a week.

The chief inspector of prisons, Anne Owers, suggested that the most serious incidents of self-harm, as well as deaths in custody, should be the subject of official investigations. In her annual report she said that the inquiries should not only ensure that help is focused on suicidal inmates, but should identify inmates who are so mentally ill that they should not be in prison. She suggested that a new network of mental health units should be set up to provide support and treatment for hundreds of disturbed offenders who could be detained there instead of in prison, where overcrowding is having an insidious and chronic effect.

Today the prison population stands at more than 75,000. The vast majority of the men and women locked up in our jails have mental health problems. Recent research by the Office for National Statistics found that seven out of 10 prisoners suffer from two or more mental health disorders. In many cases those include problems with substance abuse. Therefore, as I speak, more than 50,000 people who are mentally ill are locked up in our jails. They are supported by staff who are dedicated, but are not always trained psychiatric nurses. Many are trying to do their best in very difficult circumstances. One prison officer recently told a national newspaper: We are no longer prison officers, we are mental health workers. We are enthusiastic, but we are only amateurs. I do not like to call those people amateurs, because they are professionals, but they are not fully trained to deal with the full range of mental health problems.

First, there are the seriously and acutely mentally ill. Martin Narey, the head of the recently formed national offenders management service, which we were discussing this morning, says that at any one time there are some 5,000 prisoners who should be immediately transferred to secure psychiatric settings. It is difficult, verging on impossible, to provide the right kind of environment for those people in prisons. Prisons are not by their nature therapeutic environments, so they are not places where prisoners can be compulsorily treated. They deal with extremely disturbed people, and prison staff struggle, and do a terrific job, simply trying to contain the degree of illness and danger.

Compared with 10 or even five years ago, the transfer of prisoners who are sectioned under the Mental Health Act 1983 to secure NHS facilities is improving. It is usually possible to do it within three months of diagnosis. Even in those three months, a prisoner's circumstances can deteriorate dramatically. The situation is not as good as it should be. The chief inspector of prisons pointed out: The arrival of mental health in-reach teams in many prisons has been of benefit both to prisoners and staff, enabling those with chronic mental disorder to be better managed on the wings. I do not wish to undermine the improvements that have been made and the excellent ongoing work. Today's debate is about what more can and should be done in our prisons.

In parts of the country in which mental health trusts are unable to find room, deeply troubled prisoners can remain festering in prison for many months, locked up for many hours and remaining a danger to themselves and to other prisoners and staff. Many seriously mentally ill prisoners are not sectioned because, as they suffer from personality disorders, they are not considered to be treatable. A staggering 64 per cent. of male and 50 per cent. of female sentenced prisoners have a personality disorder. They are not always being accepted into mental health institutions, and those that are will sometimes be returned to prisons because they are too dangerous and difficult to deal with in special hospitals. Governors are reluctant to take those prisoners.

As is highlighted by Her Majesty's chief inspector of prisons, there is a policy in the Prison Service shockingly called "sale or return", whereby prisoners are sent by one governor to another on the understanding that if they misbehave, they will be returned. That is not the way in which we should deal with people who may be difficult but who have great needs and are usually damaged. A whole category of prisoners is on a merry-go-round, although "merry" is hardly the right word to use. They go from one prison to another for weeks at a time, usually to provide respite for prison staff. That does little to help them, but instead exacerbates their mental condition.

In a prison, disturbed men and women are often held away from the main wing, either in the health care unit or in special segregation units. As the independent monitoring board—the prison watchdog appointed by the Home Office—recently reported to the Home Secretary of Her Majesty's prison at High Down in Surrey: It is distressing to watch mentally ill men being shuttled between the segregation and health care units. Their condition is adversely affected by segregation, but their behaviour cannot be adequately managed in our standard prison health care unit.

There are also levels of mental disorder associated with substance abuse. I do not discount the advances made in recent years for prisoners with drug problems, but there is still a long way to go. The Government proudly tell us that more than 40,000 detoxifications take place across the Prison Service each year, but there are question marks over the quality of those detoxifications. How many of them took place in health care centres rather than on prison landings? How many detoxified prisoners received follow-up, and of what kind? The Home Office also says that more than 40,000 initial assessments were made last year under the CARAT programme for prisoners with drug problems. But how many of those initial assessments led to the full process of counselling, assessment, referral, advice and through-care? I do not underestimate the extent of what I am identifying and I realise that it cannot be solved overnight, but it is right to outline the whole situation.

How many prisoners complete treatment and rehabilitation programmes? How many prisoners have access to treatment and support services on release, and with what delay? Is there any information about the number of prisoners with dual diagnosis, and what coordinated Prison Service provisions address their needs? Those questions are all being asked by prison reform groups such as the Prison Reform Trust, but the Home Office has not provided satisfactory answers—perhaps the Minister will be able to help today.

The situation is compounded by the severe overcrowding in jails across the country. According to the Prison Reform Trust, 85 of the 138 jails in England and Wales are overcrowded and more than 16,500 prisoners have to double up in cells designed for one person. The large local jails up and down the country have in effect become vast transit camps, where tens of thousands of prisoners are processed each year. There is a danger, because the system is so overstretched, that staff will fail to identify and monitor vulnerable and the mentally unstable prisoners.

We are already seeing the consequences of cramming mentally ill people into overcrowded jails. Incidents of self-harm among prisoners have increased fivefold since 1998. Last year, there were 17,300 such incidents recorded. Among female prisoners the level of self-harm is particularly alarming. A far higher proportion of women injure themselves repeatedly. Many of them will have suffered domestic violence and sexual abuse. For them, and for the many desperate men in our prisons, self-harm is a way to release their mental pain. As one former prisoner wrote in a recent report by the Prison Reform Trust: During the two-and-a-half years of my incarceration I was to discover the depths of despair one can fall into, believing I was losing my mind, believing I was dead, believing I was buried alive, believing I would never be free. I learnt about self-harm, physically and emotionally, I learnt how to survive, yet at the same time how it feels to want to die every day … Prison is not a place for the mentally ill and too many … are there already that should not be.

In her annual report, Anne Owers says: Women in prison are at ever greater risk of suicide and self-harm. There were 14 self-inflicted deaths this year, and six of them occurred within the first eight days in prison … This places local prisons, which receive women directly from the courts, in the front line. The key elements they need to have in place are effective strategies on self-harm and bullying, effective detoxification, proper mental health support and a sufficiently active regime. None of the three local prisons that we reported on this year met all these requirements; though between them they showed that it is possible to have effective practice in all these areas. Although there were many worrying statements in the annual report, there was some light. There are those pockets of good practice—if only we could spread them more. The chief inspector goes on to say: Proper detoxification is a key part of safer custody. Holloway had extremely good detoxification, which we say should be a model of good practice. But sadly it is not a model that is followed elsewhere. In our inspection of Styal, we found that inadequate detoxification severely affected women's physical and mental health and future chances. We noted that the Governor's two bids for additional resources for detoxification had been rejected. Our report was unequivocal: 'Our strongest recommendation is that drug detoxification programmes should be introduced immediately'. It is inexcusable, that, 18 months after our inspection, this was still not the case and, in the interim, six women drug users had died there within a month of admission … Styal had no proper detoxification unit. We describe women, in their early days there, fitting and vomiting in their cells, with staff unable to do more than observe and try to alleviate their distress. This had profound and damaging effects, both on women's safety and on their chance of effective education and training. We have recently heard that the successful therapeutic project at Winchester is to be uprooted and transferred to Her Majesty's prison Send as part of emergency plans to find extra spaces and avoid holding male prisoners in police cells. That rushed plan is surely a symptom of the crisis in the Prison Service. It is difficult to imagine that those vulnerable women will not be affected by the move. The overcrowding crisis is now so great that the Government perpetually seem to be running behind the problems.

I welcome the strategy for women prisoners, which was announced on the same day as the announcement about moving the special unit at Winchester. It has long been argued that women prisoners need different treatment, and it is a sad reflection on society that the number of women prisoners has increased by 173 per cent. in the last 10 years. Their sentences may be short but the women are very vulnerable, and it is a problem for them to be located far away from their homes and families. About 50 per cent. of women are more than 50 miles from their families, and a quarter are more than 100 miles away. There are different circumstances, but it is worrying that women are receiving more severe sentences than they would have been given a decade ago for the same offences.

We must get the right message across about sentencing policy. I am not convinced that the Government always give clear signals to the justice system. There are many good schemes in the Criminal Justice Act 2003: more community service, custody plus, custody minus, and intermittent jail sentences. However, women are still going to prison when other settings would be more appropriate.

Research by Young Minds concludes that more than 1 million children have a mental disorder and half of all children who have been involved with the police have a mental disorder. That is not to say that all children with a mental disorder offend, but it is important to expand children's mental health services rapidly as a preventive strategy to help to such vulnerable children.

I welcome the fact that the Government have invested heavily in child and adolescent mental health services. We might speculate that some of the problems that we face might not be quite so desperate if that investment had been made earlier. In my former life as a councillor, I was frequently frustrated by the lack of money for children's mental health; although the Government have done an enormous amount, there is much more to be done. I am straying from Home Office to health issues, but one reason why I wanted this debate was because we need joined-up thinking to tackle the issue from all sides.

Why have prisons become dumping grounds for the mentally ill? The answer is simple: according to the mental health charity Mind, 50,000 psychiatric beds have been lost over 20 years. There is nowhere for people to go when they have a mental breakdown, and that often leads to prison for people who commit minor offences. The courts are remanding increasing numbers of mentally ill offenders in custody to await pre-sentence psychiatric reports, because there are not sufficient places available in bail hostels.

In addition, there is a shortage of court diversion schemes so that offenders who are acutely ill or at risk of suicide can be given hospital places or the treatment they need. The solution in these tragic circumstances is not to turn prisons into treatment centres on the cheap; the solution lies outside the criminal justice system.

So much offending by mentally ill people is really a public health, rather than a criminal justice, issue. The problem will certainly not be solved by cramming more people into jails or by investing in another prison building programme, as it costs £36,500 a year to keep a person behind bars. The solution is to provide more services for mental health care, drug treatment, court diversion, and mental health support and supervision centres throughout the country. With that investment, surely we could find the money for the treatment that our mentally ill people need? Why should we continually throw so much money at our prison system, when the more prisons we build, the more demands to send people to jail fill the tabloids? Does the Minister accept that we must invest to save not only money but people, and their self-esteem?

The World Health Organisation has highlighted the link between access to physical education, work and the arts—all of which are restricted in prisons, especially at times of overcrowding—and mental health. We have had a lot of information about prisons in which the inmates are kept in their cells for up to 23 hours a day. That is all part of the crisis of a shortage of staff and space. We have a self-perpetuating crisis of overcrowded prisons, including the presence of prisoners with severe mental health conditions, who obviously absorb a lot of staff time; meanwhile, we are making the mental health conditions for other prisoners worse. That vicious circle must be broken.

I would like to see a clear strategy from the Government on mental health, because it is the biggest area that needs to be tackled to improve our Prison Service. We need genuine rehabilitation for those who offend, along with the punishment that is clearly needed for all offences—we accept that there must be longer prison sentences for those who have been involved in violent or sexual crimes. However, we also need good sense, because our prison system is not working. There might be small cuts here or there in reoffending, but I have not seen any figure of less than 50 per cent. for that, although there may have been large percentage reductions. There is a revolving-door phenomenon. When people go in through that door, those who may have entered without a mental health condition can develop one because of prison conditions. Worse still, those who should have hope in their lives are not receiving the education or support that they need, and they are not engaging in rehabilitation activities.

There is so much to be done. For those with severe mental health conditions and drug addictions, it is important to invest to ensure that there is total through-care. I hope that the Minister will tell us about both the short-term plans, which I hope are not just quick fixes, and the long-term strategy, because we have a real crisis. There are already tragedies of suicide and violence in prisons, and it will not be much longer before there is a bigger tragedy. We need action and a long-term strategy that will address the problems that I have outlined today.

2.24 pm

Mr. Paul Marsden (Shrewsbury and Atcham) (LD)

I congratulate my hon. Friend the Member for Mid-Dorset and North Poole (Mrs. Brooke) on securing this debate. I realise that an interesting debate on the Budget is taking place in the main Chamber, but it is still disappointing that so few Members are present in this Chamber.

As my hon. Friend said, the problem of mental health in prisons is avoidable and can be resolved. We are talking about some of the most vulnerable people in our society. I have often found on my travels that people who have been in prison have also been homeless or have experienced all sorts of suffering in socially deprived areas. They are people with a lot of baggage. We need to find ways to help that hardcore group of people. They have problems—and, to be honest, many of them create problems, too. Mental health services have been neglected for many years, and it is to the Government's credit that they have put their money where their mouth is and begun to address the problem that they inherited.

There is a pitiful lack of resources for helping people with mental health problems inside prisons. I remember going to Shrewsbury prison, where excellent staff attention is given to looking out for the obvious problems of the prisoners who go quiet and do not express themselves, and for those with a background of mental health problems. It also has a good counselling room, where staff can try to talk to prisoners. However, the fact remains that there are too many people in prison who should not be there.

The statistics alone are worrying, and even they belie the real truth of the heartache—the details of the cases behind the numbers. None the less, they show that in 1992 there were 41 self-inflicted deaths in our prisons, and that by 1997 there were 68; the latest available annual figure is 94. The Minister will probably say that the number of people in prison has dramatically increased for a variety of reasons, and that is right; in 1992 there were 45,817 people in our prisons on average, and the latest figure is 74,960. However, if the proportion is worked out on a pro rata basis—per 100,000 prison population, let us say—there has still been an increase: the latest statistics say that 125 people per 100,000 in the prison population commit suicide, but in 1997 that figure was 111, and in 1992 it was 89. The trend is going up, over and above any increase in the prison population. People in British prisons are now 13 times more likely to commit suicide than people in the outside world. Something is seriously wrong. There is a breakdown in the way in which our overstretched public services are dealing with this issue, because at the same time the statistics in the wider community are getting better. The Government and the Minister can rightly take credit for that. Extra resources are going into the wider mental health services and the suicide rate is decreasing; it has come down from almost 11 per 100,000 to about nine. That is good.

However, although resources are being spent and that is creating some success, not enough is being done. On 9 February,The Guardian reported: Incidents of self-harm among prisoners in England and Wales have increased fivefold since 1998". Those new figures were revealed in response to a parliamentary question from Lord Lester, QC. The annual report of HM chief inspector of prisons for England and Wales 2002–03 states: Mental health continues to be a major problem in prisons, with a large number of prisoners who have either acute or chronic mental disorders. We have noticed some improvement in moving seriously mentally ill patients to NHS care". The Government were right to do that. The report continues: Nevertheless, three months"— the target time for assessment— is a long time for prisons to hold seriously ill, often potentially violent, prisoners that they cannot treat and who deteriorate visibly. The regimes available in healthcare centres rarely provided the support and stimulation that such patients need.

Likewise, on 9 February inThe Birmingham Post, Professor David Wilson of the university of Central England said: Prisons seem to be for the homeless, people with social problems and the excluded. It is a disgrace to our nation. They are for locking people up, not treating people with mental problems, no matter how many times they offend. He warned that if prisons continued to house the mentally ill they would lose the public's respect, and I think that he is right.

My hon. Friend mentioned problems at Styal prison in Cheshire. Five of the six women who died there last year were in the induction wing, which was found to be "isolating and forbidding". There was inadequate provision for mental health treatment and there were inadequate facilities for dealing with drug-dependent prisoners. I am sure that the Minister will say that action is being taken on that, and that there will be extra resources. Nevertheless, surely we have to change the procedures and expand capacity—possibly in the community, certainly in secure mental health hospitals—to make sure that such people, who should be treated, do not constantly go in and out of prison. That is counter-productive in every way.

The present situation produces many problems on the streets, as I saw recently when I spent an evening on patrol with special constables in Shrewsbury. I was with them between half-past 5 in the evening until half-past 11, when they finished the patrol, and the first four call-outs were all to deal with problems on the streets caused by people with mental health problems who were known to the police. The policemen told me that in each case, all they could do was to calm the people down and move them on; there was simply no provision for getting mental health workers out in the evening. The police pointed out two individuals who had criminal records and who had previously been to prison. It is only right and proper that we make those responsible for crimes and for their actions to pay for their actions, but there are clearly too many people on our streets and in our prisons who are not necessarily responsible. Prison is the wrong place to send them.

Finally, the Prison Reform Trust has said: One in five men in prison, and nearly 40 per cent. of women, have attempted suicide at some time—rates that are much higher than in the general public. At some stage in their sentence most prisoners are going to experience personal distress, mental health problems, drug dependency or a lack of family support—all factors which increase the risk of suicide. With almost two people a week now committing suicide in our prisons, it is time that this terrible tragedy came to an end.

2.33 pm

Mr. Mark Oaten (Winchester) (LD)

I, too, congratulate my hon. Friend the Member for Mid-Dorset and North Poole (Mrs. Brooke) on securing the debate. Often prisons and matters to do with mental health are seen as a Cinderella issue. However, this debate is not the only one we have had today; it follows the debate this morning on the soon-to-be-established national offenders management service. That debate set the background for the new structure that the Government are putting in place, and I hope that the Minister will make it clear that one urgent priority for that new system will be to address some of the issues that my hon. Friend has raised; the two subjects work closely alongside each other.

My hon. Friend was right to focus on some of the figures involved. There are 5,000 individuals with serious mental health issues in prison, whom all the professionals recognise should not be in prison. Beyond those 5,000, there are a considerable number—seven out of 10 prisoners—who have some form of mental illness. Those are damning figures indeed.

My hon. Friend mentioned what took place at Feltham some time ago. I visited Feltham a couple of weeks ago and I would like to put on record the enormous progress that has been made at that institution. I was extremely impressed with what I saw—the dedication of the staff and the way in which they have turned round an organisation that had the problems to which my hon. Friend referred. The institution—touch wood—now has a regime that has calmed things down and is making enormous progress. I was extremely impressed with the work that they do there.

My hon. Friend made a damning point about the cost of keeping individuals in prison: £350 a night. Imagine how that money could be invested in tackling mental health problems. It is a very large sum. If we could put all that into solving some of the problems that she mentioned, that would surely be better value for money.

I also thank my hon. Friend the Member for Shrewsbury and Atcham (Mr. Marsden) for his contribution, in which he made three or four telling points. He drew attention to the increases in the prison population, and mentioned an extremely damning figure, which I had not heard before: people in prison are 13 times more likely to commit suicide than those outside. One would have thought that people would be less likely to commit suicide in a secure institution, and that they would be secured from that vulnerability and put into a system that would make them safer. It is an absolute disgrace that they are 13 times more likely to commit suicide.

I concur entirely with my hon. Friend about the experience of going out with the police on a Friday or Saturday night. I did that in my constituency too, and it was amazing how the police knew the names of all the individuals. Sometimes they even knew the medication that some of them should be taking, and were asking them whether they had taken it. On the streets on a Friday or Saturday night, the police were almost like mental health experts themselves. Without that knowledge, people can often misinterpret behaviour, not understanding that there is a mental health reason behind it. One can easily see how such disturbing behaviour can lead individuals into prison. My hon. Friend was right to raise that concern.

The background to this debate, as has been said, is the increasing prison population. I do not want to go into the issues behind that, other than to put on the record the fact that we are heading towards a crisis. We know that the Government are trying to juggle the figures every week, to avoid police cells having to be used to cope with the numbers involved. Something must be done in the system to tackle the growing numbers of folk in prison, as prison cannot do the job that we would all like it to do. The problem manifests itself in move away from the concept of a community prison to prisons that have no connection with the community in which the prisoners are held. Prisoners are always being moved up and down the country.

My hon. Friend the Member for Mid-Dorset and North Poole raised the case of my own constituency prison, Winchester, where the decision has recently been taken to close the women's prison and to move the therapeutic community experiment that was taking place there—the only experiment of its kind in Europe. I have visited it, and the concept of giving the prisoners some responsibility is exciting. They set their daily timetable and consider the prison's agenda and the tasks that take place there. Most importantly, individual prisoners start to have some responsibility for how their lives are run. Such issues are all too often taken out of their control when they go into an institution, and when they leave prison, not having had responsibility for themselves can cause great problems.

That is excellent work; I acknowledge that the Minister has been helpful in keeping me posted on the issue, and I do not criticise him for his communications. He has reassured me that the unit will move to a different location, and stay together as much as possible. He recognises, as I do, the importance of keeping as many of the women and staff that started the experiment together when they move. When he responds, perhaps he will be able to update me on negotiations with staff, as we obviously want to persuade the staff who are taking part in the experiment to relocate, at least in the short term, to keep it going. However, the point remains that moving prisoners around the country like that cannot be good for the purposes that prison is supposed to serve.

The debate is not about prison and reoffending, but something is wrong with a system that allows 87 per cent. of 18 to 21-year-olds to reoffend. It is a national scandal that 87 per cent. of the individuals in that captive audience come out and commit a crime again. The figure is 57 per cent. for the rest of the prison population—something is clearly going wrong.

We cannot debate education and training today, but we must do more to ensure that individuals leave prison with the ability to read and write. and the skills to get a job. However, none of that can happen while the size of the prison population is going out of control and the staff are under increasing pressure. The prison officers to whom I speak about issues related to prisoners with mental health say, "Frankly, Mark, it's enough for us to be able to get through the day, to make sure the prison is secure and that we don't have riots or other serious incidents on our hands. Don't talk to us about prisoners with mental health or health problems, or about trying to get more education and training. That's an ideal that we could move towards, but we're trying to survive from day to day."

Others have rightly mentioned the chief inspector of prisons' report—the language used by the inspector is strong, and I am glad that she took some trouble to raise concerns about the mental health of prisoners. I will quote one example that the inspector gave in connection with my local prison. About mental health problems at Winchester prison, the report says: Patients had a very impoverished day, with very little activity: only out of their rooms for two to three hours at most on many days. Disturbed young men should have some space and human contact. The conditions in which we hold ordinary prisoners—who often stay in their cells for 23 hours a day—are unacceptable, but those conditions are particularly acute for prisoners who have mental health problems. If someone is in that sort of environment without contact, without exercise or sport or anything purposeful to do, that will not help with the condition that they had when they entered prison. Indeed, it is likely to make that condition worse.

The inspector discussed some examples of good practice, and the mental health inreach teams that have been put in place in several prisons. Could the Minister give us an update on the progress in establishing those teams? How many are there, and what sort of progress is being made putting them into as many prisons as possible? Those teams have a role to play in solving the problem.

The inspector also raised the question of assessment, and the importance of ensuring that when someone arrives in prison an assessment takes place quickly. The target is that the assessment should take place within three months. As my hon. Friend the Member for Shrewsbury and Atcham said, that is not a particularly effective target, because someone in that condition should not have to go for three months without any proper assessment.

However, I want to draw the Minister's attention to an assessment that should happen even before that—the one that happens to a prisoner in the first five or six hours after they arrive at the prison. I am extremely concerned that the assessment procedure for a prisoner who has just arrived remains inadequate. That is not necessarily the fault of the Prison Service; it may be the fault of the back-up system. If someone arrives at a prison, it is important that medical notes and any case history or doctor's evidence are made available as soon as possible. I know that in some of the cases of suicide that occur in prisons, which often happen in the first 24 hours, that crucial back-up information has not been made known to the prison. I hope that the Minister can tell us what can be done to improve not the three-month assessment of prisoners' mental health needs, which is more complicated, but the assessment within 24 hours, so that any indications on a medical note or a doctor's note that there could be mental health problems are spotted quickly. We know that those first 24 hours are critical.

My hon. Friend the Member for Mid-Dorset and North Poole mentioned the work of the children's charity Young Minds. In a briefing that Young Minds gave to a number of MPs a couple of days ago, it said that some 95 per cent. of young prisoners have a mental health disorder. It seems that among young prisoners and young offenders, problems with mental health are more acute. I hope that the Minister will acknowledge that and will see what can be done for those particularly vulnerable groups.

Both my hon. Friends mentioned suicide figures and self-harm, and I do not wish to rehearse those issues. However, there is another set of figures that I am concerned about: those to do with attempted suicide. The Minister gave me an answer to a question on that issue a couple of Mondays ago. We know that suicide and self-harm rates are increasing in prisons, but I was concerned to find that in 2002, some 154 prisoners were resuscitated. That means that they were in such a vulnerable state that they were trying to commit suicide. Last year, 211 prisoners were resuscitated. Those figures are alarming: they could so easily have added to the suicide rate.

Obviously, the good news is that those people were resuscitated. Fortunately, something happened in the system to prevent them from committing suicide when they were so close to doing so. The bad news is that we need to look at the self-harm, suicide and resuscitation figures as a whole, and they show that there is an increasing problem with suicides and the threat of suicides in prison. In response to my question, the Minister said that there was a three-year programme to develop policies and practices designed to reduce prisoner suicide and manage self-harm in prisons. He said that the results of that programme and research would inform future suicide prevention and self-harm management strategy. Will he let me know when that three-year programme is due to conclude, and what early indications he has received of the kind of programmes that the Government will put in place following that?

I have a final question about mental health in prison, relating to the practice of DNA testing people in prison. I understand that the Government's policy involved a prisoner DNA sampling exercise. That took place between February and September 2003. The aim was to take a DNA sample from all convicted offenders held in prison or mental health establishments. I am slightly concerned, and wanted reassurance, about the way in which DNA tests are carried out on those with mental health problems. I understand that people held in mental hospitals who have been found unfit to plead or have been acquitted of an offence on grounds of insanity are also included in the DNA testing process. Will the Minister run the rationale for that past the House, and give us reassurance about exactly how the process takes place? Obviously, that is a sensitive issue, given that those concerned have been found unfit or insane.

What is the way forward? I think that we should start to recognise that prison is not like hospital. If a person is ill and has something wrong with them, and they go to hospital, something happens in hospital to put that right; they go into a bed, have drugs or an operation, and come out better. In contrast, if a person goes to prison, although something is wrong with them, nothing happens to them in prison to put it right. That is the opposite of the way in which the hospital service works. People stay in prison and do not come out—and when they do come out, unfortunately, a large majority of them are not better, and have to go straight back to prison.

Is it not our aim that the philosophy and principles that apply to the treatment of those going into hospital should also apply to those going into prison? That must be the overarching aim towards which the Government should move. However, they also need to recognise that prison may not be the most appropriate place to deal with those with mental health problems. That means moving towards more community prisons, so that those with mental health problems are near local services, and perhaps family back-up and support, which can be invaluable. That is better than family and relatives having to travel miles to visit such people. It also means reducing overcrowding in prisons, and giving prison staff responsibility and more space, so that they can look after those with mental health issues and get involved with those problems.

That approach means understanding why people with mental health problems are sentenced in such a way. Most importantly of all, it means understanding why those with mental health problems are committing the crimes that lead to sentencing. I accept that that goes way beyond the Minister's remit and involves general cross-cutting policy. Surely at the heart of the issue is the need to understand why people with such problems get into the crime culture in the first place. I am grateful to my hon. Friend the Member for Mid-Dorset and North Poole for raising this important issue, and I hope that the Minister can tackle some of the points raised and find a positive way forward.

2.50 pm

Mrs. Cheryl Gillan (Chesham and Amersham) (Con)

I add my congratulations to the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) on raising this debate. The Minister and I have spent a considerable amount of time in this Chamber today. This is our second debate, this morning's having been on the national offender management service, and the two subjects are interrelated. Indeed, we could have run one debate into the other, which would have given us a welcome opportunity to consider all the relevant issues. I, too, am sad that there is such a dearth of Members in this Chamber today, but as you know, Mr. Deputy Speaker, there are other attractions today in the main Chamber. Some of us have not even managed to have our lunch yet, as we have been running between the two Chambers. Sometimes I wonder whether Westminster Hall could not be re-timetabled to allow us to have some normality in our lives.

The subject chosen by the hon. Lady is not glamorous or often highlighted, as it almost seems taboo to discuss mental health. However, one in four people will suffer with mental health problems at some stage in their lives, so everyone in this Chamber will know someone—a friend, relative or colleague—who has had mental health problems, whether in their early or their later years.

Mental health issues cover a broad spectrum, from post-natal depression to psychotic behaviour and from Alzheimer's to schizophrenia, so we are talking about the full range of illness. Whatever incidence is found in society at large, it is concentrated in the prison population, and whereas once we hid our mentally ill in asylums, we now find them in our prisons.

The Minister will be familiar with the Prison Reform Trust, as it does such sterling work in this area. It provides us with some grim statistics, which possibly need some updating—I hope that Minister will be able to fill in the gaps. Most prisoners have significant mental health problems, and some 72 per cent. of male and 70 per cent. of female sentenced prisoners suffer from two or more mental health disorders. Neurotic and personality disorders are particularly prevalent: some 40 per cent. of male and 63 per cent. of female sentenced prisoners have a neurotic disorder, which is more than three times the general population. Some 64 per cent. of male and 50 per cent. of female sentenced prisoners have a personality disorder.

I want also to consider the position of older prisoners, as 85 per cent. of prisoners over 60 suffer from chronic illness, and I hope that the Minister can shed some light on how many prisoners currently in custody suffer from Alzheimer's or other debilitating diseases that generally affect people later in life. A significant number of prisoners suffer from a psychotic disorder—7 per cent. of male and 14 per cent. of female prisoners exhibit signs of one, which is 14 to 23 times the level in the general population.

Other hon. Members have spoken about the increase in reported incidents of self-harm among prisoners and the alarming statistics on prisoner suicides. I understand that there have been 27 suicides in our prison system already this year. I hope that the Minister will comment about the change in how suicides are investigated, as they will soon be investigated by the prisons ombudsman. It would be helpful to know whether, in the course of those investigations, the ombudsman will consider the mental health of the deceased and the treatment that they received, or did not receive, when they entered the prison system. That is a sensitive and painful subject for the families of those who have committed suicide, but we may be able to learn some lessons and adjust our practices and procedures in the prison system to ensure that more prisoners do not lose their lives. A high proportion of prisoners have been treated in psychiatric hospitals. Some 20 per cent. of male and 15 per cent. of female sentenced prisoners have previously been admitted for in-patient psychiatric care. The Prison Reform Trust has done some work on the female prison population, and as many as 40 per cent. of the women whom they interviewed reported having received help or treatment for mental, nervous, or emotional problems in the year before going to prison. There must be some early indicators that we may be missing.

I hope that that sort of information will inform the way in which we handle women in the prison system. There is no doubt that there has been a vast increase in women going to prison. That must be considered closely, because if women are imprisoned there are tremendous social on-costs and implications, particularly if they have families. As we all know, if a woman in prison has a family, she loses her home and her children go into care, and a cycle is set up whereby the children, too, can end up in the criminal justice system. The Minister must reassure me, and others, that he will carefully consider the mental health issues as they apply to women.

There is another alarming statistic from the Prison Reform Trust, upon which I hope that the Minister will throw some light. Research suggests that people are twice as likely to be refused treatment for mental health problems in prison as outside. I understand that the Government's social exclusion unit concluded that mental health care in prisons was in significant need of improvement. That is an understatement, bearing in mind the number of prisoners who have been identified as suffering from significant mental health problems. If a high proportion—some 50 per cent.—are turned down when they ask for mental health treatment in prison, we have an even bigger problem than I thought.

There is a shortage of mental health professionals working in the prison system, as I think everybody would acknowledge. I acknowledge that progress is being made—certainly, that seems so from the answers to my questions to the Department of Health—and there are targets for increasing the number of mental health professionals in prisons, although I am not entirely convinced that those targets have been met, and that the numbers are fully up to the levels anticipated by the Department.

It is troubling to think that anyone who is mentally ill and has a brush with the law could find themselves in surroundings that are almost Dickensian and are certainly inadequate for the treatment that they require. I believe that I am right in saying that facilities often amount to little more than sick bays with limited primary care provision. The assessment of a prisoner on his or her arrival at prison typically takes just a few minutes, and is often conducted by a retired GP or a locum, who may not have specialist knowledge of mental health. The level of training of staff does not always match the complexity of the conditions with which prisoners present.

Earlier, I briefly met some of the representatives from the Salvation Army, which does some sterling work in this area. They look at a throughput of some 60,000 people and have identified the complexity of need. They are finding that some of their methods are helping to deal with the complex needs of mentally ill ex-prisoners and people still in custody.

The report from John Reed, the medical inspector at Her Majesty's inspectorate of prisons, states: A period in prison should present an opportunity to detect, diagnose, and treat mental illness in a population … hard to engage with NHS services. This could bring major benefits not only to patients but to the wider community by ensuring continuity of care and reducing the risk of re-offending on release. The fact that that opportunity is not grasped is an indictment of the current system. InNursing Times in 2000, John Reed said something that strikes horror in all our hearts: that many prisoners are quietly mad behind their cell door and are not getting any treatment. Care for mentally disordered offenders in prison is a disgrace.

That was written in 2000, but we still need to reform many areas of the Prison Service as a matter of urgency. Research is still required to determine the impact that the prison environment, and in particular, overcrowding, to which I referred in this morning's debate, have on mental health. As we have the luxury of more time in this debate, I hope that the Minister will update us on the latest figures for the prison population, which exceeds 75,000. As the Prison Service is in crisis in terms of numbers, will he tell us what arrangements have been made and how many police forces are on standby for Operation Safeguard? As the hon. Member for Winchester (Mr. Oaten) noted, the police have to take the overflow from the system, and that worries all hon. Members.

I was also worried to read "Securing Our Future Health: Taking a Long-Term View", the interim report by Derek Wanless. Part of that dealt with the costs of mental illness and the savings that could be made by introducing a better system, and it says: It is difficult to estimate the exact value of potential savings, but it does not seem unreasonable to assume that there might be a 5 per cent. reduction in the costs of mental illness and a 2 per cent. reduction in the costs of crime … giving a net saving across government as a whole of some £3.1 billion a year. That may be so if the nettle is grasped and the problem dealt with as Derek Wanless recommends. What will the potential savings be if the system is improved, perhaps along the lines that the Minister started to explain this morning, but did not quite finish?

I appreciate that some progress has been made. I spoke to Steve Gannon at Holloway prison, where he has made great strides in the treatment of mentally ill prisoners over a very short period. He told me, and I believe it, that the inreach teams have made a big impact, mostly because they came in with a little money. Having resources attached to the inreach teams works wonders.

However, there are still tremendous difficulties. For example, it is difficult to allocate key workers to a prisoner, because prisoners are often moved around the country. Will the Minister comment on the reports that women prisoners are being moved out of Winchester and Edmunds Hill as we speak, because of overcrowding, so that male prisoners can be accommodated? How will those individuals receive the continuing support that is needed? If prisoners are moved around the country, they will be away from their home, friends and support systems. There is an obvious social dimension to mental illness, and if support systems are not accessible, the individuals involved are less likely to benefit from interventions, and the outcomes will be poorer.

I am also worried about the transfer of the responsibility for commissioning to primary care trusts. How will that fit in with the new structure of the national offender management service? Will that money be ring-fenced, or will it go to options that are more attractive to the PCTs than mental health in prisons? I hope that the Minister will reassure us about that, because I am thinking particularly about the pressure under which PCTs operate at the moment. Many of them are turning in deficit budgets. The transfer of responsibility and the dedication of that money is extremely important to improving the conditions of prisoners with mental health problems.

There appear to be limited resources to identify prisoners with learning difficulties. Those prisoners have a number of problems, and need to be identified at an early stage, not least for their own protection in some instances. What resources are available to identify them?

Starting a process is always difficult. I appreciate that there have been targets for the number of staff working in mental health teams in prisons, and a number of my questions have been answered. However, the nine-week basic training that prison officers receive is not only cursory, but almost wholly inadequate.

I am particularly worried about the lack of information on the treatment of mental health disorders in each prison establishment. I asked the Secretary of State for Health how many people were employed to treat such disorders in each prison establishment, but I was told: This information is not available. The answer continued: By March 2004 we expect to meet the NHS Plan commitment for 300 additional staff to provide specialist community type mental health services to over 5,000 prisoners."—[Official Report, 23 February 2004; Vol. 418, c. 289W.] If, however, we do not have the information on how many staff work in the area, I lack confidence in the way in which the Government are handling the prison system.

The enormous problem that we are discussing could well be exacerbated by the major reorganisation being carried out by the Government. Once again, we look to the Minister to reassure us that he is in charge of the situation—that he has the necessary information at his fingertips and an action plan to deal with it.

3.6 pm

The Parliamentary Under-Secretary of State for the Home Department (Paul Goggins)

This is indeed the second time that some of us have attended a debate in Westminster Hall today, and the first debate was on similar issues. I admire the capacity of the hon. Member for Chesham and Amersham (Mrs. Gillan) not only to participate in debates, but to ask the Prime Minister a question, meet the Salvation Army, and, no doubt, table another half dozen questions to me for written answer. I pay tribute to her energy. I compliment the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) on obtaining this very important debate. She spoke this afternoon as she always does, whether in Committee or on the Floor of the House—with great care, knowledge and concern. It does her great credit that she brings such issues to our attention in that way. She asked many questions, some of which I hope to be able to answer during this debate. On those that I do not answer, I will write to her, as I will to other hon. Members.

Behind some of the hon. Lady's factual questions lay deeper questions about how correctional services are organised, who prison is for, and how we can effect changes in sentencing so that people who need and deserve to be in prison are in prison, while people who can be dealt with in the community are in the community. Those issues were also at the heart of the debate that we had earlier about the national offender management service. The discussion will continue, and I want to encourage it. I want people to participate in it not only in Parliament but throughout the work force, because we must get the system right. Too many people who are in prison today should not be there, and could be dealt with more effectively in the community. Whether or not they have mental health problems, or are first-time offenders, or non-dangerous people, more of them should be in the community, and that is the direction in which the Government want to move.

A number of statistics were used about the prevalence of mental illness in prisons. I shall add two statistics that show the seriousness of the challenge that we face: 90 per cent. of prisoners have at least one significant mental health problem, and 20 per cent. have four of the five major mental health disorders. This is, therefore, a very serious issue, and not one that the Home Office or I, as the Minister responsible, seek to shy away from. We are facing the issue head on, and trying to devise solutions.

The overall aim of the programme to improve health services for prisoners, which we began in 2000, is to provide prisoners with access to the same range and quality of health services as the general public expect to receive from the NHS. There should be equality of access to health care whether one is in prison or in the community. Of course, ensuring that prisoners have access to good health care can improve their physical and mental health. In so doing, we increase the extent to which they can participate in education, work on offending behaviour, and other aspects of prison life. In turn, that improves the potential for their successful rehabilitation and resettlement in the community.

"Changing the Outlook", the Government's strategy for modernising mental health services in prisons, was published in December 2001. It set out a vision of where prison mental health care was expected to be in three to five years' time and identified the steps that would need to be taken if that vision were to be realised. "Changing the Outlook" was published against a widespread consensus that the care and treatment of prisoners with mental disorders was in need of drastic improvement. The hon. Member for Mid-Dorset and North Poole referred to the independent monitoring board for a particular prison. I receive reports from all the independent monitoring boards for prisons throughout the country, and they still regularly raise the issue of the mental health of the prisoners for whom they have responsibility. It was also acknowledged in "Changing the Outlook" that the best way to achieve and maintain an improvement in prison health services in general is for prisons and the national health service to work ever closer together. I have been asked this afternoon about the move to the commissioning by primary care trusts of health services for our prisons. I am pleased to confirm that from April this year, 18 primary care trusts will be commissioning services for the prisons in their area. The commitment is clear that by 2006, all prisons will have health care commissioned by primary care trusts. I am sure that, not least because of additional investment, as well as the professionalism that is being developed, we will have better health care in general, as well as better mental health care, in our prisons as a result of the close partnership between the NHS and the Prison Service.

The Department of Health's NHS plan, which was published in 2000, included firm commitments that by 2004, the 5,000 or so prisoners who at any one time have a severe mental illness should be receiving more comprehensive mental health services in prison. If there is one matter over which I take issue with the hon. Lady, it is the description of 5,000 prisoners all needing to be in hospital. Those people with those severe mental health problems do not all need to be in hospital, any more than a member of the public with a severe mental health problem who lives at home in the community needs to be in hospital.

It is possible to provide appropriate primary and secondary care for people in the community and for those in prison, and that is what we strive to do for the 5,000 people whom we estimate have a severe mental health problem. The NHS plan also confirmed the Government's view that all prisoners with severe mental illness should be in receipt of treatment, and no prisoner with a serious mental illness would leave prison without a care plan. Indeed, there is a clear commitment within the new partnership between the NHS and the Prison Service that 300 additional staff will be employed in providing mental health services in prisons. I am pleased to confirm that we are on target to deliver on that promise, and that those 300 members of staff will be employed in our prisons.

The means by which the commitments in the NHS plan are being implemented is the prison mental health inreach project. The hon. Member for Winchester (Mr. Oaten) asked me for some updates on the project, which began in 2001. Dedicated funding has been made available to provide mental health services for prisoners along similar lines to the community mental health teams that already provide mental health services in the wider community. The inreach project began at 18 establishments in England and four in Wales in 2001–02, and was extended to another 26 sites during 2002–03. This year, a total of £10 million will be spent on NHS prison inreach services in England alone, as professional teams are developed in another 46 establishments. We can see that the investment is there and that the inreach work is extending ever further throughout the Prison Service.

Resources are also being made available to tackle the more specialised mental health needs of the small number of prisoners held in close supervision centres. Between March 2004 and March 2006, I expect NHS mental health inreach investment to double so that it reaches £20 million a year by 2005–06. That means that within the next three years, the services will be available to every prison in England and Wales. The extra investment will also help many of the existing inreach teams to expand the services that they currently offer.

"Changing the Outlook" signalled the intention to establish a prison mental health collaborative to support and empower staff to modernise clinical services for prisoners with mental health problems. I am pleased to say that that collaborative action is now well under way, in partnership with the National Institute for Mental Health in England and the NHS modernisation agency. Its aim is to identify and share good practice, as well as to identify the training required as we try to modernise clinical services in our prisons. Central to that approach is the determination to empower staff, to bring about better peer group support and to improve satisfaction for service users.

There are two other developments in prison mental health care that I would like to draw to the attention of the Chamber. We know from research that prison reception screening processes were failing to identify up to three quarters of prisoners who had a severe mental illness. Several hon. Members referred to the fact that many of those people were missed at the point where they were received into prison custody. To rectify that, new triage-based reception health screening arrangements have been developed and successfully piloted. They focus on identifying and managing a prisoner's needs on first reception into prison custody. That work has been closely linked to the development of the Prison Service's suicide prevention strategy. Much comment has been made and many questions have been asked about that this afternoon, and I will return to the subject in a short while.

Four of the reception screening pilots form part of the Prison Service's "Safer Locals" programme, and as a result there has already been a substantial improvement in the identification of prisoners with severe mental illness. I am pleased to confirm that that new approach to reception health screening is now being phased in at all local prisons, in a programme that will be completed this year.

We remain firmly attached to the principle that prisoners who need in-patient treatment for their mental disorders should be transferred to hospital as soon as possible. The number of prisoners transferred to hospital as restricted patients under sections 47 and 48 of the Mental Health Act 1983 rose from 180 in 1987 to 785 in 1994. It then remained relatively stable, at an average of 745 each year, until 1999. In 2001, 635 prisoners were transferred to hospital. In 2002, the latest year for which we have figures, the number was 639.

Generally speaking, the arrangements for assessment and transfer work smoothly, and many mentally disordered prisoners can be transferred to hospital quite quickly. I was pleased that the hon. Member for Mid-Dorset and North Poole made a positive comment about that. Increasingly, we are able to identify and move people on more rapidly than we used to. I am the first to accept that delays still occur in individual cases. Some prisoners have to wait longer than we would ideally like before they can be transferred to hospital. At any one time, there are likely to be about 40 prisoners who have been waiting for three months before being transferred to an NHS hospital. We appreciate that such delays can be enormously distressing for the prisoners concerned, the prisoners around them, the staff, and the prisoner's family and friends.

The prison health team and NHS regional commissioners of forensic mental health services have examined ways to reduce the time that prisoners might have to wait for a hospital place. Tighter regular monitoring has been introduced, together with a protocol that sets out the actions required of the Prison Service and the NHS when a prisoner reaches that three-month deadline. I emphasise that it is a three-month deadline, not a target. As I said, at any one time there could be 40 people who have reached that deadline. When someone reaches it, everything is done to ensure that they are moved as quickly as possible.

Following the publication of "Changing the Outlook", all prisons, in collaboration with their local NHS partners, undertook a detailed review of their mental health needs and developed action plans to fill any gaps in services that they identified. We do not underestimate the challenge—indeed, no participant in the debate has underestimated the challenge that we face, but we confidently expect that in the next three years or so there will be further progress. For example, fewer mentally disordered prisoners will be accommodated in prison health care centres, more resources will be deployed to provide day care and support on prison wings, and there will be a reduction in the average time that mentally disordered prisoners spend in the remaining prison health care beds. There will also be a more appropriate skill mix among those who provide mental health services in prisons, and quicker and more effective arrangements for transferring the most seriously ill prisoners to appropriate NHS hospitals and transferring them back when appropriate. I expect ever closer collaboration with NHS staff in the management of prisoners who are seriously mentally ill, including those who may be vulnerable to suicide or self-harm while they are in prison.

Several hon. Members raised the issue of population pressures. It is true that there are more than 75,000 people in prison—75,059, to be precise. We have plans in place to ensure that we can continue to expand prison capacity; we have added 14,700 places to the prison estate in the last six years and we will add another 2,500 this calendar year. We intend to ensure that we stay ahead of the undeniable pressure in the system.

Mr. Oaten

I understand the capacity problem, but can the Minister confirm that no cells will contain three people as a result of the attempt to maximise capacity?

Paul Goggins

No cell designed for one person will accommodate three people, as was the case not so very long ago. Cells designed for two people may accommodate three people, but the days of three people in a cell designed for one are, thankfully, over.

We will not be making routine use of police cells as part of Operation Safeguard, although it may be necessary to make occasional overnight use of a police cell, as is done now if there is a lockout, and when someone is held overnight prior to being moved to another region. It is not appropriate for prisoners to be held in police cells, or for police officers' time to be tied up in looking after and supervising those prisoners. I am adamant that we will not make routine use of police cells as an extension of the prison estate.

Mrs. Gillan

Can the Minister confirm that he is moving women prisoners from the two prisons that I identified earlier? How many women prisoners are involved, and where will they be moved to?

Paul Goggins

Yes, I can confirm that there is a re-roll, as it is called, at Winchester prison, in the constituency of the hon. Member for Winchester, and at Edmunds Hill. It was a step that had to be taken in view of the rising population pressure on prisons. When there is a re-roll, staff must be informed; questions are asked and detailed discussions have to take place. I can confirm that the therapeutic community will go to the prison at Send, and we will try to maintain the momentum of that important work.

There is some good news: in June we shall open a new prison for women at Ashford, because of the projected increase in the population of women in prisons, which has risen dramatically in recent years, far outstripping the general increase in the prison population. The number of women going to prison is levelling off, which means that we can open the new prison and re-roll the existing women's prisons for men. We can therefore provide newer accommodation for women, and additional accommodation for male prisoners.

I am not running away from the fact that the prison population is under enormous pressure. I return to my previous point that we must rebalance the system so that those who need and deserve to be in prison are in prison, and those who can be dealt with and supervised in the community are in the community.

In opening the debate, the hon. Member for Mid-Dorset and North Poole forcefully drew attention to the serious and interrelated issues of suicide and self-harm in prisons. Of my many responsibilities, I regard that as of the highest importance. Too many people self-harm or take their lives in prisons, and we must do everything possible to drive that number down. There were 94 self-inflicted deaths last year, and 14 of those people were women; a disproportionately higher number of women than men took their own lives. There have been 26 self-inflicted deaths so far this year, and 24 deaths have occurred in prison for other reasons. Those figures are high. Every death in custody—I am notified immediately of every one—is deeply distressing, and a tragedy for the individual and their family, no matter what they have done to end up in prison.

It is sometimes suggested that overcrowding is a direct cause of suicides and self-harm. The prison population is a related matter, but more important is the degree of movement in the system because of population pressures. People are moved around the system more quickly, and vulnerable people are more exposed to risk. That, rather than simply the numbers involved, is the problem. The prison population includes a large number of people who come into custody already struggling to cope with a wide range of problems including drug and alcohol abuse, difficult family backgrounds, histories of sexual and physical abuse, and the problems of mental ill health that we have discussed.

I have a couple of points to make in response to questions that were put to me. A question was asked about detoxification, and reference was made to the chief inspector's report on an inspection at Styal prison. I am happy to say that things have progressed substantially at Styal since that inspection. The detoxification programme is now in operation; the money was already there but the problem was in recruiting staff to run that programme. I visited the prison last July and was concerned that the detoxification programme was not up and running, but since September it has been operating. I visited again in January and was pleased to see and hear directly from the prisoners about the difference that the programme is making. Every woman who needs one is on a methadone programme, and the system is better than the previous one.

Mention was also made of the CARATs system and the staff who work on those programmes. I am sure that hon. Members visit prisons in their constituencies and elsewhere, and will be aware of the fantastic work done by CARATs workers. I was in Norwich prison last week and met some of the team. The work that they do with prisoners to try to keep them off drugs, and to follow them once they leave prison to ensure that they receive the necessary support in the community, is essential.

The role of the ombudsman was also raised in relation to Styal prison. I commissioned the ombudsman to undertake an investigation into the six deaths that occurred over 12 months at Styal to ascertain what similarities there might have been between those deaths. Stephen Shaw produced an excellent report, and has also produced one or two other reports. From 1 April, he will be responsible for investigating all deaths in custody. That is an important step because, despite the fact that there is an investigation into every death in custody, the greater independence of Stephen Shaw and his team will be invaluable. Tragic as every death in custody is, we must learn whatever lessons we can from each one.

I can confirm that last week, the women's offending reduction programme was published—

Mr. Deputy Speaker (Mr. Frank Cook)

Order. We must now move on to the next debate.