Examination of Witnesses (Questions 20-39)
MS FRANCES
CROOK, MS
PAULINE CAMPBELL,
MS DEBORAH
COLES, MS
JULIET LYON
AND MR
GEOFF DOBSON
8 NOVEMBER 2005
Q20 Mr Streeter: I appreciate what you
are saying and all the work that you do. Is it not true that we
do not care for people with mental health challenges outside of
prison very well in parts of the country under any government,
we have a problem knowing what to do with people? Is that not
part of the problem with prisoners, that there is not much capacity
or knowledge of what is the best thing to do outside the system
and we have got to tackle them both at the same? Is that a fair
comment?
Ms Crook: Yes.
Ms Lyon: I think it is better
outside. It is certainly a comment that one of our trustees makes
continually when we are focusing on the prison system because
she chairs one of the health trusts and in her view there is a
lot of work needing to be done outside. If you look at people
sleeping rough, people who have left the Armed Services, the sort
of people who get swept in and out of prison often for short periods
of time, there is a high degree of mental health need. If people
do not have an address they somehow do not exist and that would
be true for many health services as well as prison response.
Q21 Chairman: In general most people
seem to have said that the transfer of health responsibilities
from the NHS to the Prison Service has been a good thing. Given
the circumstances you have all recently described, is there a
case for these prisoners of giving the new NOMS system some formal
responsibility for arranging or commissioning mental healthcare
given that there does not seem to be a really sharp ownership
anywhere in the health service for meeting the needs of this particular
group of prisoners? I float that as an idea. I am not quite clear
whether the NOMS approach with its focus on offender management
has the potential to do things differently or whether that is
a side issue.
Ms Lyon: I would worry about that
because I think that we should be calling on NOMS—and indeed
it is aware of it—to track their offender management pathways
alongside and in line with health pathways, but to ask NOMS to
take on a health task or to take lead responsibility would take
us backwards. The fact that we recognise that healthcare belongs
with health is right and really the pressure should be much more
with the health trusts, the PCTs, those who do carry the responsibility
now to take forward the reforms that they say that they are planning
but remain in policy rather than in practice.
Q22 Nick Herbert: I would like to turn
to the issue of children in custody and specifically to you, Deborah,
because of your submission. In the submission you raise a number
of cases of awful incidents of young people dying in custody and
you mention the incident of Joseph Scholes who died over three
years ago at the age of 16 in custody. The Coroner called for
a public inquiry into that incident; the Government has said no.
That is now going for judicial review. Given that another five
children have died in penal custody since, three in the last 18
months, I wonder if you could explain what issues that case gives
rise to and why a public inquiry would be the right way forward?
Ms Coles: Joseph Scholes was an
extremely vulnerable, disturbed young boy who was sentenced to
a Detention and Training Order at a time when there was much public
disquiet about mobile phone theft. At his court hearing the judge
felt that he had to give Joseph a custodial sentence. At the time
of giving the sentence he said that he wanted Joseph's suicidal
history and vulnerability brought to the attention of the authorities.
He was sentenced to Stoke Heath Young Offender Institution where
he spent an extremely difficult nine days, many of the days in
strip clothing, in a strip cell and in virtual isolation. There
was a very well-conducted inquest. The family had good representation.
We had a very sympathetic Coroner. He recommended a public inquiry
because the remit of the inquest meant that very important questions
could not be addressed, in particular about the sentencing policy,
about why it was that a very vulnerable young boy ended up in
prison accommodation rather than in a local authority secure children's
home accommodation where there would have been a more child centred
approach to his many problems. He also mentioned the whole issue
about vulnerability, about working with some very, very damaged,
troubled children and particular concerns about the use of strip
cells and strip clothing for children. There were a number of
issues that could not properly be explored at that inquest. I
think everybody who attended that inquest, particularly the jury,
were very shocked by what they heard. The Coroner obviously felt,
as we did, that there needed to be a broader inquiry into learning
the lessons to try and ensure that these deaths did not continue.
Obviously you have identified the fact that since Joseph died
there have been another five children's deaths. We are working
with the families of four out of those five. All of those cases
raise very, very similar questions as the death of Joseph Scholes
raised, which is why we really think that there is an opportunity
within a public inquiry to have a proper holistic look at the
whole issue of children in the criminal justice system and particularly
the way in which we deal with very, very vulnerable children who
are at risk of suicide and self-harm.
Q23 Nick Herbert: Are those questions
essentially about where children are sent to in the first place
or are they questions about the handling of children once they
are in custody? In its memorandum to us the Home Office has said
that it has put in place a suicide prevention strategy that has
better ways of dealing with children, support groups and so on.
Could you comment on those strategies and be more specific about
which of the two elements the public inquiry should be looking
at, the sentencing or the treatment of children afterwards?
Ms Coles: Both. You are absolutely
right on the allocation of children, where do children go? Do
they go to Young Offender Institutions? There is evidence that
the Youth Justice Board brought out yesterday saying that the
secure children's estate is running at 97.7% capacity. They have
not got the places to send children which means that more of them
are ending up in prison rather than in local authority secure
children's homes that are being closed down. The whole point about
the public inquiry is it needs to look at all these different
issues and that is the big problem about the current investigation
process, it cannot address the wider issues. Those wider questions
about allocation, where children end up and suicide prevention
strategies you need to look at in a holistic way. The problem
at the moment is that these things are looked at either in isolation
or not at all and that is what is frustrating the learning process.
Q24 Nick Herbert: Juliet, would you like
to comment on the prevention strategies themselves?
Ms Lyon: I would. I would just
like to support INQUEST's call for this public inquiry. I learnt
from Joseph's mother that the reason he was sent to custody was
because he had a serious offence in his past. The serious offence
in the past occurred while he was trying to kill himself. He took
an overdose, jumped from a window, had a tussle with the ambulance
driver and was then convicted of assault. That is my understanding
of what happened. The offence involved his already trying to take
his own life. I feel nothing less than an inquiry is going to
shine a light on the fact that our institutions for young people
are not full of happy, healthy adolescents; they are full of the
most damaged and the most ill. We know that one in 10 has a psychotic
illness, which is far higher than in the general population. What
we are doing is putting severely mentally ill children into conditions
where staff do not have any chance of trying to protect them and
keep them safe. I would just like to read you a tiny bit from
the research I did for the Home Office which was the young people
speaking. It came up because there was a research project proposal
looking at whether you can have a control group of young people
who have not been exposed to the distress of other youngsters
and a study group of youngsters who have been exposed to suicide
attempts and the distress of others. There was no control group
available across the prison system because all these young people
had been exposed to distress. This is what a tiny group of young
men under 18 said. One said, "Well I can understand people
hanging themselves, but when people cut their wrists that's just
nasty. It was just coming out of his arm . . ." Another one
said, "When I was in one YOI about three people tried hanging
themselves." Another one said, "Everyone used to be
at their doors laughing. But it ain't funny, they're mad."
One said, "If you see for yourself mate, you get a shock."
The last one said, "When you hang yourself all your problems
are solved." That is just a tiny snapshot of what young people
in prison talk about when you give them the chance to talk.
Q25 Nick Herbert: Could one of you comment
on the Government's programmes for suicide prevention, their safeguards
prevention programme and the suicide prevention strategy that
they have and the effectiveness of that?
Ms Crook: On young people specifically?
You cannot design out misery, particularly with young people.
I visited Feltham recently and these young people never go outside.
You can tie the beds to the floor and you can have a bureaucracy
that supports it and you can have as many forms as you like, but
if you have got 800 teenage boys who never go outside and who
never run and who never see the sky or feel the rain on their
face and are cooped up in what amounts to a modern dungeon, because
that is what it is, then you are going to have high rates of bullying
and high rates of self-injury.
Q26 Nick Herbert: Do any of the witnesses
have any comment to make on the effectiveness of the Government's
specific strategies for suicide prevention or their Safeguards
Development Programme?
Ms Lyon: In Young Offender Institutions?
Q27 Nick Herbert: Yes.
Ms Coles: The suicide prevention
guidelines that were in operation for Joseph were exactly the
same ones that would be in existence for an adult prisoner. There
is not a specific emphasis and recognition about the vulnerability
of children. That is slightly different in secure training centres
where two of the five children have died since Joseph. This is
a strategy that does not recognise and appreciate the difference.
In terms of staff training, the staff are not trained to work
with damaged, vulnerable children, they are trained to work with
prisoners across the board. I think that would be another point
about the suicide prevention strategies and about the specific
vulnerability of children, that staff do not have the benefit
of such training or awareness.
Q28 Nick Herbert: To what extent is bullying
a problem in all of this? I think you have drawn attention to
the problem of mental health in all of this, but is there another
aspect which is peer group bullying? Is this a contributory factory
to the incidence of suicide?
Ms Crook: Yes. We dealt with the
case of a young boy recently who was in a big YOI. We were representing
him because he was being punished because he refused to go to
education. When people go from education and there is a free flow
system that is when all the bullying happens. Again it is about
high numbers but low staffing levels. Sometimes the staff have
training but they are not educated. I think education and training
are different things. If you have people coming in who are not
well educated, you can do a two-day training course, but they
do not have the range of skills, the sociological understanding
and the childcare understanding to see when these things are happening.
There is a lot of bullying in YOIs partly because there are low
levels of activity. In this particular YOI there is a new education
block but it is only used half the day, so the other half of the
day the kids are milling about with nothing to do except torment
each other. They have got all this energy and that is where they
put their energy, into tormenting themselves and each other. You
cannot deal with that unless you put in a very busy regime including
lots of exercise. The Howard League has set up an inquiry, which
is going to be reporting later on this year or early next year
under Lord Carlile, looking specifically at the use of restraint
and it was triggered partly by the death of Gareth Price in the
training centre and segregation punishment and forcible strip
searching. Bullying happens partly amongst young people bullying
each other, but the institutions bully young people too.
Q29 Mr Streeter: Is part of the problem
that people who become prison officers traditionally tend to be
fairly tough, rugged, macho people, male or female, who would
not look out of place in the All Blacks front row? Is the problem
that some of the skills that one is seeking to be taught, the
intuition skills, do not sit very comfortably with this macho
image, is that part of the issue or am I completely barking mad?
Ms Coles: I think you have raised
an important point about the difference between staff working
in a Young Offender Institution and staff working in a local authority
secure children's home where the staff are there and they know
they are there to offer a child centred, focused regime and approach.
I do not whether you are hearing evidence from the POA. I am sure
that they would be interested in what you had to say. A couple
of weeks ago there was concern raised by somebody quite senior
within the Prison Officers Association about the fact that we
needed to stop treating children in prison as children; in other
words, we were getting too soft on kids that were ending up in
Young Offender Institutions. I think there are some who think
that that kind of culture towards recognising children as children
is not the one we should be adopting within YOIs, so it would
be worth seeking more evidence about that.
Mr Dobson: There was some research
published this week by the Centre for Criminal Justice Studies
which showed that many prison officers would welcome the opportunity
to become more involved in education and I think that is something
that we could look seriously at.
Q30 Mrs Cryer: The statistics show that
6% of the prison population are women, but 15% of the suicides
are among women, and more than half of those resuscitated have
been women. There seems to be an imbalance. Why do you feel there
is this disproportionate desire to commit suicide amongst women
than amongst men? What do you think can be done to address the
specific needs of women prisoners? What steps could the Government
take to reduce the number of women who are being sent to prison?
Ms Coles: We are currently conducting
research based on the number of women who have died since 1990
and what that research is highlighting at this early stage is
the fact that the majority of women who have taken their own lives
and the high numbers who self-harm have either drug and alcohol
problems or mental health problems, and I think that is fully
recognised and I think it is becoming increasingly recognised
across Government. The Fawcett Society has been commissioning
some research into women and the criminal justice system. I think
the answer to the first question would be the kind of women that
we are sending to prison. The specific issues affecting women
are that they are often primary carers of children and the fact
that they are accommodated great distances from home which means
it is difficult to maintain family ties. There is some harrowing
evidence about the number of women who try and kill themselves
or self-harm around, for example, Mother's Day. I think there
has been a serious problem—and the Styal deaths highlighted
that—around the treatment of women with drug problems, particularly
the lack of properly run detoxification facilities and the whole
way in which drug withdrawal is monitored, the regimes and conditions
operating within many of the women's prisons in terms of out-of-cell
activity, particularly issues around abuse, domestic violence
and sexual abuse, very particular needs of women that I think
it is very, very difficult for the prisons themselves to deal
with. I have put in my submission about the death of the woman
in Durham, the most recent death. That is an institution that
the Chief Inspector of Prisons has called for twice to be shut
down because of her concerns about the regimes and conditions.
You only need to read the inspectorate reports to get an idea
of the kind of women that are being sent to prison and the very
difficult job that staff have in trying to keep these women alive.
Q31 Mrs Cryer: We are being told that
we need more prisons; there just is not enough space. Instead
of building new prisons should we be building more hospitals,
more treatment centres, for women who are on drugs?
Ms Coles: I could not agree with
you more. We have looked at this across the globe in terms of
the fact that people with mental health problems should not be
in prison. In terms of women, there is very, very grave concern
about the lack of alternatives to custody, about the fact that
there are very few women-only bail hostels, there is very limited
numbers of secure psychiatric hospitals. I am not talking about
the big hospitals like Rampton and Broadmoor, women do not need
that type of security, but there is a need for some women to have
secure community provision. We also need to make magistrates and
the judiciary generally aware of the alternatives to prison that
could better deal with the reasons why these women got into prison
in the first place and their many complex needs.
Ms Campbell: With the six women
who died at Styal Prison, Cheshire, in that 12-month period, four
of those women were actually mothers. There is no disputing the
fact that the separation of the mother from her children causes
a great deal of distress to a woman. When a lot of these women
leave prison they have perhaps lost their home, they have lost
their job and sometimes their children have to go into care. Women
entering a prison situation generally seem to take with them a
greater mix of problems than many male prisoners do. The main
thing that concerns me is that most of these women just should
not be in prison at all. Nine out of 10 women offenders have been
convicted of non-violent offences. Two-thirds of women prisoners
are mothers. It really begs the question what are these women
doing in prison? Most of them should not be there. It exacerbates
their problems.
Q32 Mrs Cryer: We are also punishing
the children.
Ms Campbell: Absolutely.
Q33 Mrs Cryer: Let me just move on to
remand prisoners. Remand prisoners tend to commit suicide at a
much greater rate than the sentenced population. What steps can
be taken to reduce suicides among remand prisoners, and should
the number of bail hostels be higher?
Ms Crook: It is very difficult
to get more bail hostels because people do not want them in their
local area, they are not popular. How many of you would like them
in your constituencies?
Q34 Chairman: I have got one and I voted
for it when I was a councillor, too.
Ms Crook: It is a very difficult
issue. Offenders are not popular people and these are very serious
issues. I think the lead given by politicians to support and encourage
community-based systems, whether it is bail hostels or sanctions
for people who have been convicted, is incredibly important, particularly
for people who are on remand and who have not been convicted of
an offence and who are still theoretically innocent before the
law. The number of people on remand is going up and that is true
of juveniles as well and it is the most vulnerable time. They
are the people who suffer the worst prison conditions in the most
overcrowded prisons. They get very little activity or support
in prison because they cannot be made to work and anyway there
is not any work in most of the local prisons. We would like to
see more support systems in the community, whether it is hostels
or other kinds of support, but my appeal is to turn it back to
you as politicians and your responsibility for encouraging that
both at a national and local level and we will work with you to
support that.
Mr Dobson: There was a call a
few years ago in what was called the Halliday Report for a national
review of what was dubbed the intermediate estate, which covers
all hostel provision—"approved premises". That
was one of the few recommendations in the Halliday Report that
was not taken forward and not looked at seriously. I think this
Committee might well want to have a look at that. If you look
at the approved premises at the moment, increasingly places are
being used for sex offenders, understandably, because they are
difficult to place elsewhere and many of whom are sex offenders
on release from prison. There is a need to keep a careful eye
on what remains available for bail places. Just to link the remand
question with the questions about women in prison: about two-thirds
of women going into prison are received on remand and many of
those are received for psychiatric reports and that seems quite
wrong, the fact that they are received into prison for psychiatric
reports.
Q35 Mrs Cryer: What do you think about
the Government's strategy for dealing with self-harm and suicide
amongst remand prisoners? How widespread do you believe the use
of tagging is as a condition of bail?
Ms Crook: I think we have dealt
to some extent with the Government's strategy already. There is
no difference in it for remand prisoners or for sentence prisoners.
We are all part of the ministerial group that has been reviewing
this and we have gone through more Ministers than I can remember!
The policies have been developing and that is to be welcomed and
there is training and there is support. People who are on remand
face particular problems because they face such an uncertain future
and they have got the worst conditions. We know that the death
rate amongst prisoners, not just suicide but other deaths, is
that eight people have died this year from other suspicious circumstances
as well as the suicides and some of them may have been suicides,
some of them not. That was particularly amongst people who are
on remand or who have just been received into custody. They are
very vulnerable people. The only way to save those lives is to
reduce the unnecessary use of custodial remand. Tagging may be
one way, bail conditions and support may be another, but the courts
will not take that risk with children or with adults if the atmosphere
is so vengeful and punitive that they are frightened of being
vilified in local newspapers. Every single decision made by magistrates
and by the higher courts is open to scrutiny, which is absolutely
right, but they are under enormous pressure. At the moment if
they decide, "Well, I'll just be cautious this time and use
a custodial remand as opposed to a community tagging or something
else," it can lead to a death. It only takes one decision
a year by each magistrate to have 30,000 extra prisoners.
Mr Dobson: I did just want to
follow up a question on tagging. If you look at electronic monitoring
and the way its use has developed in this country, it is largely
a back-end use, that is after use of custody. There has been relatively
little emphasis to date on it as part of a community penalty or
associated with remand and I think that we could make much more
use of it provided it is for short periods and coupled with supervision.
For people on remand there has got to be some kind of safe accommodation.
It is worth thinking about the Supporting People strategy which
was supposed to give some priority to offenders and ex-offenders
and I think in some parts of the country that is not producing
the necessary accommodation.
Q36 Mr Browne: We were told earlier that
587 out of every 1,000 women prisoners self-harm, that is more
than half of women prisoners self-harm.
Ms Coles: I am sure that the Government
will give you this. The new edition of Safer Custody News
gives a breakdown of self-harm trends amongst women and young
people. You can have a look at this. It gives you it in graphic
detail. The fact is that women account for 58% of all self-harm
incidents even though they form only 6% of the prison population,
and that is another figure in terms of the number of women who
have been killing themselves, it is a disproportionate number.
Q37 Mr Browne: Self-harm gives a wider
picture of the levels of despair whereas the suicide levels give
you a very thin top picture. 58% of prisoners who self-harm are
women but more than half of women prisoners self-harm.
Ms Coles: Yes.
Q38 Nick Herbert: I wanted to pick up
on the points about electronic tagging because Frances mentioned
the vengeful atmosphere which you felt was preventing the use
of non-custodial alternatives, such as tagging, which are important
if we are going to deal with some of these issues of suicide.
Would you not accept that there is some legitimate public concern
about incidents where people who are on tags have committed other
crimes and that public confidence in the system is going to be
very important if those alternatives are to be pursued?
Ms Crook: Of course, every crime
committed, particularly any serious crime committed, while somebody
is on any kind of early release scheme is much to be regretted.
However, these people would have been released anyway. I am not
convinced that taking people to the end of their sentence and
then releasing them with no support or monitoring or supervision
at all is a safer way than what we have at the moment. I have
never been a great fan of electronic surveillance. I think human
support and the Probation Service and other kinds of human networks
are preferable, but that is more expensive. All the prisoners,
apart from 20 or so, are going to be released. The question is
how do you release prisoners into the community to give them the
kind of support which enables them to re-integrate successfully
and to be useful citizens and not to commit further crimes? They
do need support on release. Tagging can be part of that. Human
support to make sure that they have got somewhere safe to live,
that they have got enough money to make sure they do not have
to steal to get it, that they have got proper drug rehabilitation
facilities and they have got alcohol use support are absolutely
essential if they are not going to commit further offences and
not going to kill themselves because the hidden death toll is
amongst ex-prisoners who go on and kill themselves on release.
This was drawn to our attention when a friend of one of my staff
members was released from Holloway Prison and within a week had
jumped off a bridge in Archway Road. As a result of that, we did
the first research into how many ex-prisoners have committed suicide
and it is an increasingly high death toll.
Q39 Chairman: Can I ask a question myself
and it takes us slightly back to the beginning of the session
and I am now wanting to try to draw together some of the strands
here. We have had a lot of discussion at the beginning of this
session about suicide and overcrowding, but having established
at the beginning that overcrowding is a factor in suicides, much
of what we have discussed in the last quarter of an hour really
seems to be centred on things which are inherent in sending this
particular group of people or these particular groups of vulnerable
people to prison as opposed to overcrowding. We will have the
Minister here in a very short time, so to what extent would it
be fair for the Minister to point to efforts to reduce overcrowding
as a key element in their strategy to reduce suicides, whether
they are trying to do that by building more prisons or more community
centres or whatever, or are they really in the wrong place if
they are trying to reduce suicides?
Ms Crook: You cannot build your
way out of the problem. It is as simple as that. If you build
more prisons, they are full up before they are built because the
message is to the courts and to the public, "Prison is the
answer, therefore, use it". The history over the last 30
or 40 years has been that you cannot build your way out of the
problem; you have to stem the flow, you have to stem the supply
because prisons get overcrowded before they are built and that
is why you have the list of the top 20 overcrowded prisons with
90 deaths in them, very simply.
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