Clause
20
Removal
of requirement to appoint a medical officer
etc
Question
proposed, That the clause stand part of the
Bill.
Mr.
Garnier:
Again, I want to highlight an issuethat
the Government need to demonstrate increasing awareness of, namely,
health provision for the mentally
ill inside prison. I started the debate last week,
but the matter is perhaps more appropriately dealt with under clause
20.
Under clause
20(1), the Prison Act 1952 is amended where section 7(1) makes
appointing a medical officer for each prison a requirement. That
provision will now be omitted. I can understand the policy, because now
health services are provided within prison by the national health
service through the local primary care trust. Patients in prison are on
the list of a local GP practice, or covered by some other arrangement
made by the PCT, so a dedicated prison doctor is no longer necessary.
However, if we are not to have a dedicated prison doctor, we must
surely have proper facilities for the treatment of the mentally
ill.
The problem
cannot be just brushed under the carpet. Lord Phillips, the Lord Chief
Justice, speaking to the all-party parliamentary group on substance
abuse in March 2006 in this building,
said:
“Many
actual or potential criminals are dangerous because they suffer from
personality disorders or other mental conditions which can be diagnosed
as illnesses. Prison is not the best place to detain those who are
mentally
disordered.”
Sadly,
however, all sorts of people with mental disorders are sent to prison,
partly because the national health service no longer has provision for
residential care of the mentally ill, which, in fairness, partly flows
from the failure of the care in the community systemto cope
with many of the people who have mental illnesses. A number of people
who live rough or commit crimes of violence are mentally ill. They may
be mentally ill because they have a mental problem that has occurred
naturally, or the balance of their mind has been affected by drugs. It
does not matter why they are ill, however; what is important is that
once diagnosed, they receive the appropriate treatment. It is
regrettable that prisons are used—I say this not only as a
politician but as a Crown court recorder—as adjuncts to the
national health
service.
Mental health
problems are worryingly prevalent among those entering prison: 72 per
cent. of males and 74 per cent. of females in prison suffer from two or
more mental disorders, compared to only 5 per cent and 2 per cent.
respectively of the general population. What is more, 20 per cent. of
men and almost 40 per cent. of women entering custody say that they
have attempted suicide. In the past decade, one prisoner has committed
suicide every four days.
There is no point in saying
that mentally ill offenders would be better managed outside prison and
would be better off if they never entered prison in the first place.
That is uncontroversial and has been stated by Anne Owers, the chief
inspector of prisons. Her estimate, based on visits to prisons, is that
41 per cent. of prisoners held in health care centres should be in
secure national health service accommodation. The Lord Chief Justice
agrees. In relation to prisoners suffering from mental disorders, he
says that
“many of these
would be better detained in mental
hospitals.”
Treatment
of the mentally ill in prisons is far from ideal. I appreciate that the
ordinary prison officers who do the health work in prisons do their
best, but they are not trained to deal with mentally ill people. As a
result of overcrowding in prisons and the insufficient number of prison
officers looking after prisoners, particularly at weekends, the
mentally ill are left in their cells instead of being given appropriate
treatment.
There are mental health in-reach
teams in 102 prisons, but at any one time there are likely to be at
least 40 prisoners who, having already been assessed, must wait three
months or longer before being transferred to hospital. Many more have a
long wait before an assessment takes place.
Far from helping to cure mental
health problems, the environment and the regime of prison seem likely
to exacerbate them. Research has shown that 28 per cent. of male
sentenced prisoners with evidence of psychosis reported spending 23
hours or longer in their cells each day—more than twice the
proportion of those without mental health problems who spend that
length of time in their cells. Suicide attempts and incidents of
self-harm are frighteningly high. Nearly a third of women in prison
injure themselves an average of five times, and 6 per cent. of men do
so twice.
Jonathan
Aitken, who involuntarily became something of an expert on prisons, has
written this about his time in
prison:
“On the
wing, there was plenty of evidence of behaviour brought on by mental
distress...one young man only ever wore the same pair of jeans and
a green nylon cagoule. He never wore shoes or socks, never went out on
exercise, hardly ever spoke to anyone and was understood to have been
taken advantage of sexually by predatory prisoners...Another had a
habit of inserting objects into his body: a pencil in an arm,
matchsticks in his
ankle.”
The conclusion
that he drew, and that I draw, is that prison does little to address
the many and severe mental health problems of its inmates. That has
consequences for the resettlement needs of released prisoners with
mental health problems, because those needs are not being identified or
met. Some 96 per cent. of mentally disordered prisoners, including 80
per cent. of those who have committed the most serious offences, are
put back into the community without supported housing. More than three
quarters are given no appointment with outside mental health experts or
carers. According to the Government’s social exclusion unit,
more than 50 prisoners every year commit suicide shortly after
release.
Hidden
behind the apparently uncontroversial clause is an enormous problem
that is getting worse and needs to be tackled. If the Government are
not to have a dedicated medical health officer in every prison because
of the new arrangements with PCTs, it is incumbent upon them to ensure
that there is, not merely some mental illness care, but more than
adequate mental illness care for people going into prison, those in
prison and those coming out of prison. I do not attach personal blame
to the Minister, but the Government can no longer say, “Well,
this is something we have inherited.” They have been in office
for 10 years. I look forward to some words of reassurance from the
Minister.
Clause 20(3)
makes ineffective section 17 of the Prison Act 1952, which bans painful
tests carried out by medical officers on prisoners in order to detect
malingering or for other purposes. Why is a painful test for any
purpose necessary? Will the Minister explain precisely what is the
purpose of removing section 17, and therefore the ban on such tests,
and say what will happen instead? I cannot believe that any humane
medical officer would deliberately hurt anyone, although some
investigations clearly require discomfort
to be inflicted on a patient. I look forward to hearing the
Minister’s explanation of clause 20(3) and ofthe
removal of obligations under section 28(5) of the 1952
Act.
Mr.
Sutcliffe:
I shall deal first with the reality of the
clause and how it affects the Bill and then return tothe hon.
and learned Gentleman’s concerns about mental health provision
and to the wider debate about mental health
issues.
The clause
removes the requirement for prisonsto appoint a medical
officer. The role of the medical officer in prisons is long outdated;
its creation in legislation reflected the custom and practice in
prisons long before the creation of the national health service and
before the Prisons Act 1952 in which it appeared was passed. It
represents the old way of providing health services to
prisoners.
With the
recent transfer of responsibility for prison health services in public
sector prisons to the national health service, the great majority of
prison health services are now delivered under the general provisions
of the National Health Service Act 1977. Local primary care trusts now
commission those services and the continued existence of the prison
medical officer is at odds with the modern national health
service.
When it was
first implemented, the medical officer role represented a mix of
managerial, practical and clinical duties, some of which we would now
view as inappropriate for a clinician. Over the years, the role has in
practice evolved considerably to keep pace with the modernisation of
the service. It has moved from the tradition of the person with that
role being an officer of the prison towards a more appropriate role,
equivalent to that of a community
GP.
The removal of the
medical officer role servesto support the significant
improvement and modernisation of prison health services that has taken
place in recent years. It also reflects the enormous cultural change
that needed to take place in prisons to effect those changes. The
clause removes outdated, unhelpful terminology that acted as a barrier
to the delivery of practical and cultural change in prison health
services. The change ensures that the future of the prison health
service is within the NHS, with health services provided via the 1977
Act, in line with services for the rest of the population. That is the
reasoning behind the clause, which hon. Members will understand in
relation to the purposes of the Bill.
Rightly, and understandably,
the hon. and learned Gentleman raised the issue of mental health
problems in prisons. I agree with him that there are people in prison
with mental health problems who do not need to be there and we should
make every effort to ensure that their needs are
addressed.
Mr.
Robert Flello (Stoke-on-Trent, South) (Lab): Will the
Minister give me reassurance and comfort that the flexibilities in the
Bill will allow some of the superb work with people who have mental
health problems that is carried out by the not-for-profit sector in an
almost non-statutory, much more easily approachable manner, to be
developed and applied in the Prison
Service?
11
am
Mr.
Sutcliffe:
Very much so. I am grateful to my hon. Friend
for pointing out the role of the not-for-profit sector and I would hope
to see that work not only continue but develop in the way that he
outlined. The hon. and learned Member for Harborough said that prison
officers were not trained in mental health awareness. He is wrong. We
have invested close to £500,000 in training 9,000 prison
officers in mental health awareness, so there are prison officers with
the skills. Clause 20 does not affect the current ability of prison
officers to develop health and safety training and to look at how they
deal with a situation. It does not affect the chain of command if there
is an attempted suicide and the medical officer needs to be called. The
procedures are all in place.
The hon. and learned Gentleman
concentrated on the role of the Prison Service in relation to mental
health problems. He will know, because he deals with some of the issues
in his other role, that the disposal of people with mental health
problems who have committed an offence is a matter for the courts. So
the courts have a major role to play when they receive the reports on
individual
cases.
Mr.
Garnier:
Of course the Minister is right, but the problem
is that there is a difference between being in such a mental state that
one needs to be sectioned and placed in a secure hospital and being
mentally ill but still short of needing to be sectioned. Many courts
frequently have to send to prison people who are not, if I may loosely
use the expression, “McNaghten mad”, but who are none the
less not well. While it would be better and preferable to send those
people whom I loosely described as not being well into the national
health system, there is not room or there are not the beds
available.
For
goodness’ sake, there are not even spaces for mentally ill
people who do not commit crimes; we know that as constituency Members
of Parliament. When we send people to prison, we have to do so
irrespective of our private wish that they could go somewhere else. As
a judge, one has to do what the law requires one to do. Once they get
to prison, the judge has no say over how the individual is cared for,
and if there is an absence of proper care there is nothing that the
judge can do about it.
Mr.
Sutcliffe:
I am grateful to the hon. and learned
Gentleman, who brings to the Committee experience of the role of a
judge. I am not making the case that it is all down to the courts, but
there is a role for the courts to play in terms of some of the
diversion schemes that have been put in place for mental health
assessments to be undertaken so that the courts can be provided with
information about an offender’s mental condition and any
treatment that may be appropriate. I take the point that it does not
meet all circumstances and some of the needs may not be apparent at
that court process.
I
am not labouring the point and saying that it is all down to the courts
and it is no one else’s responsibility, because clearly it is a
responsibility and we have as a Government tried to make significant
improvements to the mental health services available within prisons
through the development of the new NHS mental
health in-reach services, which are backed up by an investment of more
than £20 million a year. As the hon. and learned Gentleman says,
there are in-reach teams in 102 prisons, including 60 staff now in
post. They ensure that mentally ill prisoners are assessed as too ill
to remain in prison so that they can be transferred to a hospital
setting appropriate to their care and security under the requirements
of the Mental Health Act. In 2005, 24 per cent. more
prisoners with mental illness too severe for them to be in prison were
transferred to hospital than in 2002. The figures were up to 896 from
722. There has also been a decrease in the number of people waiting
more than 12 weeks for a transfer to hospital. In the quarter ending
June 2006, 44 prisoners were waiting, down from 62 in the same quarter
in 2005, so we are showing a significant improvement. We are also
running pilots that explore the possibility of reducing the 12-week
waiting standard to just 14 days.
The hon. and learned Gentleman
asked about prevention of suicide and self-harm. Suicide rates in
prison remain higher than in the general population, although they have
declined. Some 78 apparently self-inflicted deaths occurred in 2005, 95
in 2004 and94 in 2003. That must be put in the context of the
number of individuals passing through the prison system each
year—more than 130,000. Every death in prison is a terrible
tragedy affecting families, staff and other prisoners deeply.
Ministers, the National Offender Management Service and the Prison
Service are committed to reducing the number of such tragic incidents.
I am a member of a group of stakeholders looking at ways in which we
can do
that.
Self-inflicted
deaths in custody are subject to highly random and large cyclical
swings. The most reliable measure is the three-year rolling average.
From 2003-04 to 2005-6, that stood at 121 deaths per 100,000 prisoners,
which reflects the stabilisation of the figures over recent years. The
Safer Custody Group, whichI reported on earlier, works with
the prison andhealth services, and a variety of agencies,
looking at assessment, care in custody and
teamwork—ACCT—to help at-risk prisoners. ACCT will be
extended to all prisons in
2007.
The hon. and
learned Gentleman asked also about what we were doing for people with
mental health problems when they leave prison. Continued treatment in
the community is vital for such people and in February 2006 the Home
Office launched a five-year strategy for protecting the public and
reducing reoffending. That contains a commitment to look at ways in
which offenders receive effective mental health treatment, whether in
prison, hospital or the community. Offenders identified as having
severe or enduring mental health problems are subject to the care
programme approach during their stay in prison and on
release.
The hon. and
learned Gentleman is quite right. This is not a party political issue.
He will accept that there have been mistakes with care in the community
and that the past 10 years have seen improvements. However, we need to
go further. During the short time that I have been in my post, I have
been concerned about mental health problems in prison, particularly
among young offenders. A great deal more needs to be,
and can be done. I am working with health Ministers to improve the
situation and the Committee will be aware of the improvements in the
Mental Health Bill, which is going through the
Lords. Mental health
is an important issue, not only for the Committee, but for those
tackling reoffending and looking at a range of health needs. The hon.
and learned Gentleman talked about the number of women in prison with
mental health problems. I saw that first hand on a visit to Holloway.
It was distressing to see some people who could have been dealt with in
another way and I look forward to Baroness Corston’s report on
vulnerable women, which will come out soon. He referred to subsection
(3), which repeals the “painful tests” provisions in the
Prison Act. If he requires more details on that, I shall be happy to
write to him and to the Committee. However, with that explanation
ofthe Government’s policy on mental health and the
particular issues relating to clause 20, I hope that the Committee will
support
it.
Question put
and agreed
to.
Clause 20
ordered to stand part of the
Bill.
Clause 21
to 23 ordered to stand part of the
Bill.
| 
