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6.30 pm

The Law Society also underlined the need for more reliable information on the need and potential demand for community services for mentally disordered offenders. I have referred to the Zito case and others where a failure to ensure that appropriate community-based services were available for people with psychiatric problems led to offences that were far more serious than those that first brought those individuals to the attention of the court.

The Law Society comments that many mentally disordered and vulnerable people are currently being cared for by their families without any contact with the psychiatric health or social services, and that without the provision of adequate support and services, those

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arrangements are likely to break down. That is true. The breakdown of such arrangements can be dramatic and serious. I shall give a simple example. I am sure that many of my hon. Friends could give examples from their constituencies, and that my hon. Friend the Member for Hammersmith has professional experience that he could draw on.

A young man sought help from a mental hospital that was treating him because he felt that things were getting out of hand and that he might offend due to the development of his illness and the pressures on him. He asked for help and to be taken in. His mother said that she was seriously concerned that something would go wrong unless treatment was made available. It was known that he needed help, but he was not given it and the result was a victim, a violent offence, a criminal record and great expense to the public purse. There was little that was positive in the outcome, but a massive negative outcome, the cost of which was borne by the criminal justice system and, ultimately, by the public purse.

I understand--I do not think that the Minister acknowledged this adequately--the health service's fears about becoming an adjunct of the Prison Service. Personally, I have much sympathy for the combination order, which allows more flexible movement between one and the other. The answer is not greater separation, but greater co-operation. The basic principle, as put by my hon. Friend the Member for Stockport (Ms Coffey) when we discussed these issues earlier, is that it is important that people with a mental illness of the sort that responds to treatment should receive that treatment wherever they are held.

There should be facilities for treating people and maintaining treatment programmes in prison, and for transferring people to hospitals for short-term and long-term treatment, whichever is the more suitable. We are talking not about additional costs, but about the appropriate targeting of treatment and the matching of the individual to the treatment that he needs.

In making that point, my hon. Friend the Member for Stockport made the crucial point that, if facilities in prisons are poor, special hospitals will be chock-a-block with prison transfers, not because they provide a more appropriate environment, but simply because there is a lack of facilities in prisons. That point is surely relevant to some of the Bill. That would inhibit the special hospitals' ability to deliver treatment regimes for non-offenders. One way forward would be for the prison services to utilise special hospital skills in the prison environment through an outreach service, but the real answer is to improve the targeted service in prisons.

There is a pass-the-parcel approach and no real clarity of purpose--I suspect because prisons have difficulty coping with the bizarre and challenging behaviour of some mentally ill prisoners. Some offenders have profound personality disorders that are not treatable on a medical model. My hon. Friend the Member for Knowsley, North (Mr. Howarth) recently visited Ashworth hospital, which has separated that group out and deals with it differently. That expertise and approach is transferable from hospital to prison. It is important that special hospitals are not used as a dumping ground, but they will continue to be used in that way as long as they can be used in that way and as long as there are poor facilities in prisons.

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On the other side of that equation, the Home Office and the Prison Service will not be under pressure to improve mental health facilities in prison. The attachment of the mental illness label to all sorts of behaviour is not helpful, particularly to people who are genuinely mentally ill. The key is proper assessment at the time of sentence and proper assessment of the right disposal, taking into consideration both the offence and the clinical judgment about the offender of people in the mental health service.

This should not be a bureaucratic issue of managing beds in the hospital system or prison cells in the prison system. That is why our new clauses both address the assessment, giving full information to the court and allowing it to be able to use properly the disposals available to it, including the disposals proposed elsewhere in the Bill, and to ensure that the facilities are available to people in prison. I have said on a number of occasions that there is a great cost to the public purse, in terms both of the criminal justice system and of the mental health system, in failing to address these issues adequately.

The Minister said that our new clauses would destroy local flexibility and--I quote him directly--that it would be "unhelpful to tie the hands" of people who can voluntarily make those arrangements at local level. This is a fine time for the Government to discover, suddenly, that it is a good thing to have local flexibility, and for a Minister to say that the Government do not want to tie the hands of people to do things for the public benefit at local level. Is the Minister saying that the requirement of a high standard set at a central level necessarily involves bureaucratic interference by Government Departments? The answer to that is yes under the Conservatives, but no if it is done properly.

These things must be done with sensitivity and balance. We should set the standards and then allow flexibility for local delivery of those standards, and for the courts to be able to take decisions on the basis of the right framework having been put in place. I underline again that flexibility on the use of psychiatric nurses--and not just doctors--is allowed, at least in the initial assessment, by the way in which we have approached this issue.

The Minister suggested that we should have concentrated on the remand element rather than on post conviction. I take his point about the identification of people who need mental treatment before the case has gone through. I commented on that in my earlier remarks, but we have concentrated particularly on the point that, if someone has been found guilty, the court, in deciding its disposal, should have a full analysis of the offender's condition, as well as knowledge of the offence. I remind the Minister that this is, after all, the Crime (Sentences) Bill: so it is sensible for us to concentrate on sentencing. It was the Government's choice that we should concentrate on sentencing; that is why our new clauses and my remarks in this short debate have concentrated on sentence, rather than on remand.

The Minister suggests that the outcome is uncertain--that it is not certain what the court is to do with the information made available to it. It is not prescribed, but that is not the same as its being uncertain. It is not prescribed in the sense of slot-machine justice, whereby a piece of information is fed in and a disposal pops out, although I know that some Ministers are enamoured of

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that approach. We are trying to ensure that the court has the appropriate information to enable it to make the right decision--a decision that might, in certain circumstances, be tough, but which includes appropriate psychiatric treatment for the offender, whether through a hospital order, a combination order or a prison sentence. What is required is that the court uses the information made available to it to do the job that it is there to do--to exercise common sense in its application of the law. That is perfectly clear and not uncertain at all.

I also found it most odd that the Minister did not respond in detail to the serious intervention from the hon. and learned Member for Montgomery (Mr. Carlile). During that exchange, the most the Minister would acknowledge was that there may be room for improvement in the services available in prison. I tell him that it is not conditional and that "may be" is not the right term--there is room for improvement in the psychiatric treatment available in prison.

Mr. George Howarth: There is room for a quantum leap.

Mr. Michael: As my hon. Friend says, there is room for a quantum leap of improvement in standards of psychiatric care in prisons. I would put it more strongly: there is a crying and desperate need for major improvements in prison psychiatric treatment and in the liaison between the criminal justice system, especially the Prison Service, and the national health service in respect of the treatment of mentally ill prisoners.

Mr. Alex Carlile: Does the hon. Gentleman agree that it is simply not good enough for the Government to say that contracts are being entered into with individual psychiatrists and groups of psychiatrists to provide services in prison? Is he aware that the psychiatrists who provide services in many of the busier prisons say that under their contracts, which are part-time and limited, they are able only to stem the tide and deal with the most serious cases?

Mr. Michael: I am grateful to the hon. and learned Gentleman for making that point which, with his knowledge of the criminal justice system, he does with great authority. He confirms my suspicions that we are seeing the Elastoplast approach to mental health, just as we are seeing the Elastoplast approach to the health service and the criminal justice system in general. He makes the point effectively and I agree whole-heartedly with him.

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