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5.45 pm
Mr. Alex Carlile (Montgomery): The three new clauses and the amendment deal with three important issues. The first is the question of gatekeeping in magistrates courts to try to ensure that those who are mentally ill are recognised as such. The second deals with the nature of the provision that is available in prisons--an important issue relating to the sentencing choice made by the court. The third, which is addressed by amendment No. 37, which stands in my name and those of my hon. Friends, relates to the question whether a person suffering from mental illness, other than those who are diagnosed as psychopaths, should fall within certain of the new provisions.
I turn to the gatekeeping role--contained particularly usefully in new clause 8, which provides for pilot projects and for them to apply in selected areas. We know from statistics, which have already been cited by the hon. Member for Cardiff, South and Penarth (Mr. Michael), many articles, Home Office research and comments of prison staff that a great many prisoners, including very many who are serving short sentences for relatively minor offences, are suffering from various forms of mental illness. It is certainly correct that many who appear before
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It is extremely expensive and destructive to treat people with minor depressive illnesses and other conditions such as untreated but potentially treatable schizophrenia by locking them up in prison. Such treatment does little to resolve their mental illness. Despite what is sometimes said, it is quite clear that the treatment for minor psychiatric illnesses in prisons for short-term prisoners is lacking and, sometimes, verging on the pitiful, and that prisoners emerge from prison not having been treated for the mental illnesses from which they are suffering. It therefore seems entirely sensible that pilot projects should be set up for gatekeeper psychiatry to be made available in the busier magistrates courts.
I do not suppose that such problems arise very often in rural and small-town magistrates courts because generally people are much better known in those areas for their idiosyncrasies, there is often more time to deal with cases and probation officers know the defendants and their families rather better. If one talks to magistrates in the big cities--I had a conversation on the subject recently with a stipendiary magistrate in one of our great cities--one hears that a significant proportion of the people who appear before the courts do so when suffering from some discernible psychiatric condition. Although pre-sentence reports are prepared before any custodial sentences are passed, they do not offer a full opportunity for a medical assessment to be made. It seems sensible that, at the least, experienced psychiatric nurses should be made routinely available to carry out examinations so that those who are suffering from apparent mental illness can be screened into medical procedures rather than forced into an otherwise inevitable cycle of minor criminality and imprisonment which may ruin the rest of their lives and the lives of their nearest and dearest.
New clause 12 deals with the second issue. Courts are faced every day with choices on sentencing, despite some of the Government's best efforts. Sometimes judges and magistrates face a choice between an order that involves mental health provision and a sentence of imprisonment. Judges may feel that the level of culpability of the offender, despite a psychiatric condition, is high; and may feel that the appropriate sentence would be one of imprisonment with appropriate psychiatric provision during that sentence. Believe it or not--and some would not believe it--judges approach such problems responsibly and have a genuine interest in what happens to the people they sentence, especially if the offenders are suffering from psychiatric conditions that have affected their criminality.
Judges would be more ready, in some cases, to pass prison sentences if they knew that the prisoners' conditions would be treated appropriately in prison. In most such cases at present, the judge has no way of knowing what psychiatric treatment will be given in prison. Indeed, if a judge inquires, save in the most serious cases, about what will be done if he passes a sentence of imprisonment, he will receive no answer or the most general of answers. New clause 12 would resolve that situation responsibly.
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I turn to amendment No. 37. Clause 43 will insert a new section 45A into the Mental Health Act 1983. It will empower courts to pass prison sentences with what are called "hospital and limitation" directions on mentally disordered offenders, and section 45A(2) will provide that that power should apply to psychopathic offenders. I have no complaint about that because those powers will be useful and will enable hospital and limitation directions to be passed on psychopathic offenders. The reason for the power is that there are often doubts about whether offenders suffering from psychopathic disorder will be receptive to treatment. Psychiatry is, if the psychiatrists will forgive me for saying so, often as much art as science, and frequently a question of trial and error. It is sometimes the case that psychiatrists will be able to treat psychopaths usefully by, for example, removing the trait--by medication or other treatment--that makes the offender a danger. After treatment, a psychopath might not be especially dangerous. Nevertheless, it is right that those who bear significant responsibility for their criminal offences, albeit that they are psychopathic, should serve their sentences of imprisonment. Clause 43 will ensure that that can happen.
The new section 45A(10), however, will enable the Secretary of State to extend the power by order to cover other categories of mentally disordered offenders, including not merely those suffering from a psychopathic condition but those suffering from a discernible and diagnosable mental illness. The Bill's explanatory and financial memorandum explains that the provision in clause 43
The Reed report of 1994 was mentioned earlier by the hon. Member for Cardiff, South and Penarth. The joint Department of Health and Home Office working group, chaired by Dr. John Reed, recommended a version of the hybrid order when it reported in 1994, but it did not recommend the version that is included in the Bill. The working group's recommendation was limited to offenders suffering from psychopathic disorders. The White Paper, in contrast, proposed to make the order available for other categories of mental disorder and mental impairment. Moreover, under the 1994 proposals by the Reed working group, the offender would be transferred back to prison only if hospital treatment were inappropriate or refused, whereas the order proposed by the Government would involve automatic return to prison even if treatment were successful.
The 1996 discussion paper issued by the Home Office and the Department of Health recognised that the development of the hybrid concept beyond the recommendations of the Reed working group could raise difficulties. In particular, the paper recognised that the uncertainties about treatability which characterise psychopathic disorder are rarely present in cases of true mental illness. In cases of diagnosable and definable mental illness, it is beneficial for rehabilitation to be managed in a flexible time frame and for there to be continuity of care if the patient is to make a successful return to the community with minimum risk to the public. There is no evidence that that could be achieved if the provisions were to be extended from psychopathy to people suffering from mental illness who then found
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I do not need to repeat the protests that have arisen as a result of the proposals. Opposition in unison has come from the Royal College of Psychiatrists, the Royal College of Nursing, MIND, the Law Society, the Penal Affairs Consortium and others. I suggest to Ministers that it is not necessary to include a provision that would extend the new hospital and limitation directions beyond those who are suffering from psychopathy. There is no evidence that such powers are necessary, but there is evidence that they would be detrimental to the care of mentally ill people. Indeed, if orders are made under section 45A(10), the resulting hybrid order could increase the number of mentally disturbed offenders detained in hospital beyond the period of clinical necessity because doctors would be reluctant to remit patients to prison, either because that would be clinically unwise or because they believed that it would be medically unethical to do so. Furthermore, if hospital and limitation directions were linked with determinate sentences, some offenders might be released sooner than if they had been admitted on an indeterminate restriction order under the Mental Health Act 1983.
I urge the Minister to think again about amendment No. 37 and to leave the matter open, at least until the Bill completes its stages in another place--if that is ever to happen--so that a measure too far need not be taken.
Mr. Soley:
This interesting group of amendments and new clauses gives the Government an opportunity to work with the Opposition in looking at what my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) rightly called the interface between our criminal justice system and mental health services. The Under-Secretary of State for the Home Department will have some knowledge of this area following his previous ministerial responsibility in the Department of Health.
"will be implemented in two or more phases."
Presumably, subsequent phases will cover other categories of mentally disordered offenders other than psychopaths.
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