Examination of Witnesses (Question Numbers
200 - 204)
TUESDAY 30 NOVEMBER 1999
DR MIKE
SHOOTER, DR NIGEL
EASTMAN, MR BARRY
TOPPING-MORRIS, MR
CHRIS GREEN, and DR
SIOBHAN SHARKEY
200. Differences there may be but there are
powers to detain people who suffer from a mental illness. There
were powers before 1983 to detain all the categories that we have
been discussing this morning. We really need to know from you,
given that there are people who are both dangerous and untreatable,
however few there may be, however difficult the diagnosis may
be, given that they exist, what do you propose to do about them?
(Mr Green) What do we propose to do about them?
201. We are not asking you merely for your medical
opinion, we are asking for your opinions as members of the public
themselves.
(Mr Green) There were proposals in the 1970s, in about
1975, in the Butler Report for a system of reviewable detention
of people who had been convicted of serious offences which would
have involved greater use of risk assessment tools, a rather more
systematic system for indeterminate detention or for reviewable
detention in any case. That was in the Butler Report. It seems
to me this was a far better worked out, far better researched
and far more ethically acceptable method of dealing with the problem
you have referred to. I want to say that you are talking about
two utterly different things. You are talking about personality
disorder and mental illness.
202. I do not dispute that. The question is
to the extent, however small, that there are people who are both
dangerous and untreatable, what are you saying should be done
with them? Should they be out in the community or should they
be in a secure institution?
(Dr Eastman) Can I respond in this way: before these
proposals were published I was telephoned by a colleague at the
Home Office, I have a lot of contact with the Home Office and
Department, and she said "we have been looking at the numbers
and we have discovered that a large number of the people who we
think would be covered by these proposals could have had a discretionary
life sentence at some stage in their career, have you any idea
why that is?" I did not, so then we had a discussion about
it. What I want to build on that is, if one approaches this in
terms of behaviour, and substantial behaviour rather than just
psychopathology, the reason why it is so important is because
if you are trying to pick out one or two out of the 100,000 you
have got to go for the most robust predictors and you cannot just
go with me thinking "this person is dangerous because of
what they told me". I think one has to go towards the most
robust approach. If you look at the group of people we are concerned
about, and I do not disagree that we should be as concerned as
you are as citizens, it does seem clear that a very large proportion
of these people could have been dealt with by the criminal justice
system at some stage and were not. If I can use an analogy, and
I come back to this business of civil detention I am afraid, it
is a little bit like public policy directed by the sardine tin
approach, which is that you turn up the sardine tin but you can
never quite get that little bit at the back. What worries me is
that there are very, very substantial bases for detaining people,
both in terms of the available sentences, the range of sentences
and, secondly, in terms of a very, very loose definition of treatability.
It seems to me that what one is doing is trying to get at that
last little bit. Public policy cannot address the last little
bit.
203. You are saying you think the criminal justice
system will deal with it and the judges are saying the medical
profession will deal with it?
(Dr Shooter) Can I give you a very straight forward
answer?
Chairman
204. It has got to be a quick one as well I
am afraid.
(Dr Shooter) First of all, scotch the myth that psychiatrists
are a recalcitrant profession not interested in change. We are
sincerely interested in change and we want to co-operate with
the Government in thinking about how best to serve these groups
of people and their needs as well as public order. Secondly, we
would be wholly in favour of looking at the current system as
it stands while we are discussing a new system and looking at
where that is not best for the people involved at the moment,
where they do not get best treatment, where there are still loopholes
of dangerousness and so on. We need also to do ancillary things
like working with the judiciary and so on to make sure that they
are properly using their current rights. Thirdly, we would be
extremely interested and co-operative in thinking about any new
system that is better than the old system, if it can be shown
to be so, for looking at better forms of treatment in a multidisciplinary
context with these particular groups of people, as they come into
assessment and treatment facilities which may or may not be built
over the next ten or 20 years. But, in all that, there are two
things which as a Royal College our members would not wear. That
is, first of all, removal of treatability because what that would
do is to overwhelm the current system of general psychiatric wards
so that people coming into them from the community would be worse
served than better and, secondly, the civil detention under Option
B, which is fraught with ethical issues, all of which we have
to be certain about, and also with practicalities which we consider
in the last resort, the Government does not need to make their
options work.
(Mr Topping-Morris) Could I please add that I would
beg that we adopt a whole systems approach which begins with doing
some real work in identifying the cause of this condition at its
earliest onset which would allow us to engage in some preventative
work and at the end of the scale that we consider very carefully
the need to instal adequate after care arrangements and supervision
arrangements which will be necessarily needed because people may
continue to pose a risk. We should not concentrate on what we
are concentrating on at the moment which is the indeterminate
detention of this client group and assessment arriving at a convenient
diagnosis, it is a much bigger problem than that.
Chairman: The Committee is most grateful to
all of you, you have given us a great deal to think about, as
have all of our witnesses. Thank you very much indeed.
|
