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Dr. Godman: Amendment No. 23 says that, in addition to a constable and a mental health officer, an officer on the staff of the hospital can perform escort duties. Will the Minister confirm that most mental health officers are social workers who have undergone specific training in the mental health sector? Surely he would not expect someone to be escorted by a mental health officer--a social worker. Surely such escort duties would be undertaken by a police officer or, as the amendment says,
- "an officer on the staff of the hospital specified".
Mr. McAllion: This group of amendments deals with a new court order, which is called a hospital direction; it is sometimes referred to as a hybrid order. It gives the court new powers where offenders are found guilty of an offence that is punishable by imprisonment, but where the court judges that a prison term would not be insufficient to deal with such offenders. In addition to any prison sentence, the court is empowered to direct that the prisoners should be detained in hospital.
If the patient, or the prisoner, recovers from the mental disorder in hospital, the idea behind the hospital direction is that he would be returned to serve the rest of his sentence in prison. Amendment No. 143 seeks to deal with the damaging consequences that may arise out of that situation.
I am particularly concerned about the type of offenders who will come under the provisions of the clause. The notes on clauses make it clear the people who are affected by it--obviously, not all prisoners but only certain groups of prisoners. The notes say that the clause affects prisoners who are well enough to have stood trial, but who also suffer from a mental disorder to the extent that would warrant hospitalisation. It is the use of the term "mental disorder" that I want to bring to the House's attention. I want to plead with the Minister to think again before he commits this provision to the statute book, because it would affect people in the real world.
The idea of hybrid orders came out of a working party that was set up in 1994 by the Home Office and the Department of Health in England and Wales. It was chaired by a Dr. John Reed--not, I think, the Dr. John Reid who is Labour spokesman on defence. The working party recommended that hybrid orders should be introduced, but it made it clear that the recommendations related only to prisoners/patients who were suffering from what it termed a "psychopathic disorder".
Psychopathic disorder is one form of mental disorder that is defined in the English Mental Health Act 1983. It has a specific meaning, but it is not defined in Scottish legislation. The working party made it clear that it was concerned about whether people with a psychopathic disorder were in any sense treatable in hospital in any case. That was why it introduced the hybrid order. When the Minister transferred that concept from the working party in England and Wales to Scottish legislation, he completely misunderstood the purpose that lies behind the hybrid order.
Dr. Kirk also pointed out that, if the proposed law included all types of mental disorder,
If the threat of being sent back to prison is there when the patient is sent to hospital, the consultants in the hospital will allow that patient to block the bed in the
29 Jan 1997 : Column 409
Amendment No. 142 tries to salvage something by saying that, before someone is returned to prison, the matter must go back to court, which must be satisfied that there will not be a relapse of the condition if the patient is sent back to prison. The Minister is creating a bureaucratic maze and a nightmare for many people who suffer from genuine illness and who come before the courts. I plead with him to ensure that, before the Bill goes to the House of Lords, he will get in touch personally with people such as Dr. Kirk at the Murray Royal, and speak to them about their concerns, because we are making a terrible mistake.
Dr. Godman:
I share some of the serious reservations of my hon. Friend the Member for Dundee, East (Mr. McAllion). A court has to be satisfied by way of the written or oral evidence of two medical practitioners, by which is meant consultant psychiatrists. In the context of amendment No. 242, before a person can be transferred to the prison system would consultant psychiatrists be involved in an examination in the hospital?
Obviously, she was referring to the working party's report. She said that, if that were so, there was no problem with hybrid orders being applied to such cases, because
"in Scotland, most such people"--
those with psychopathic personalities--
"would not be admitted to hospital."
She wrote:
"By definition psychopaths are said to be unable to learn by experience. Such a definition raises questions as to whether change can be effected by hospital treatment. Furthermore such individuals are extremely disruptive and destructive in a ward to the disadvantage of other patients."
Dr. Kirk made it clear therefore that, if the hybrid order referred only to people suffering from a psychopathic personality, no one in Scotland would be concerned about the application of the clause. However, there is no such thing as a definition of a psychopathic personality in mental health legislation. The nearest we have is one of the definitions that is applied to mental illness. It states that it is
"A persistent disorder manifested only by abnormally seriously aggressive or irresponsible conduct",
which
"makes it appropriate for him"--
or her--
"to receive medical treatment in a hospital",
which
"is likely to alleviate or prevent a deterioration in the patient's condition."
Dr. Kirk is concerned that the clauses refer not to people who have a psychopathic personality or a psychopathic disorder but to people who have a mental disorder, and mental disorder has a different meaning in law in Scotland. It refers, first, to people with mental illness and, secondly, to people who have mental handicaps--mental impairment or severe mental impairment. As Dr. Kirk said, for such people prison is no kind of answer. She wrote:
"The mentally handicapped . . . have no place in a prison nor do those with mental illnesses such as schizophrenia or manic depressive illness."
Those are comments by someone who is an expert in dealing with offenders who are sent to Murray Royal hospital for forensic psychiatry, often by the courts. She should know better than any hon. Member that, if we include mental disorder in the terms of this law, we will begin to create much damage for vulnerable people in society. She said that all psychiatrists throughout Scotland would resist such people being sent to prison once they are better. For a start, she pointed out that, if anyone came out of serious mental illness and had recovered, only to be told that he was to be sent back to prison to serve the rest of his sentence, the most likely effect would be a relapse into illness, and all the good work in the hospital would be undone as a result.
"the likely outcome would be hospital beds (which are relentlessly diminishing in numbers) would be blocked by patients ready for discharge but who have to mark time while the tariff"--
the prison sentence--was served out.
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