Examination of Witnesses (Questions 1-19)
12 JANUARY 2004
MS FRANCES
CROOK, MS
JULIET LYON,
MR ENVER
SOLOMON, MS
DEBORAH COLES,
MS HELEN
SHAW AND
MS SARAH
CUTLER
Q1 Chairman: Welcome to this meeting
of the Joint Committee on Human Rights. Can I just remind everyone
that, in view of the fact that this session is being televised
and in the interests of efficiency, it would helpful if you would
ensure that mobile phones were switched off. This is our first
evidence session in our inquiry into deaths in custody, which
we are examining from the human rights perspective. We want to
address in particular the obligations imposed on the State by
Article 2 of the European Convention on Human Rights, on the right
to life, and our inquiry has two main aspects. First, the cause
of deaths in custody and strategies for their prevention; and,
second, the processes for investigation of deaths in custody,
and our inquiry is extending to deaths in all forms of custody
including prison, police custody, immigration detention and detention
under the Mental Health Act. I would like, on behalf of the Committee,
to thank our witnesses for coming here today and to thank them
and others who have submitted written evidence to us. So, if I
may begin and, in view of the fact that the areas between us are
agreed, I am sure that, between you, you will have agreed appropriate
persons to respond to individual questions. Some may argue that,
when we look specifically at self-inflicted deaths, the suicide
rate amongst detained people, it could be argued that this is
all down to inadequacies in the administration of prisons and
other places of detention, but how far do you think the prison
authorities and others are being asked to do the impossible in
that they are expected to resolve the problems of highly vulnerable
and damaged people sometimes in the prison population, which the
services within the community have been unable to resolve? So,
is it not that prison leads to suicide but that we actually imprison
people who may be more prone or are likely to commit suicide?
Ms Crook: I think there is some
truth in what you are saying, that obviously the population of
people who end up in prison are highly vulnerable and fragile.
They have had fractured and disturbed lives and they come with
a range of problems: drug addiction, alcohol addiction, having
suffered abuse of one kind or another and sometimes of course
they feel guilty for what they have done, which accounts, I think,
for the high incidence of suicides amongst life-sentence prisoners.
However, the State has a duty to protect those people and even
more so if they are vulnerable. These people are not sent to prison
to die and yet they are doing so in ever increasing numbers. I
saw in a parliamentary answer recently that the general suicide
rate amongst young women had dropped quite significantly in the
community whereas, at the same time, it is going up and rising
very significantly in prison. So, of course, we do recognise that
the prisons and prison staff have a very difficult job and we
applaud the considerable efforts that have been made, mostly as
a matter of policy and sometimes as a matter of practice, in saving
lives and supporting people. At the bottom, the best way to protect
people who are vulnerable is to have good relationships with them,
so that, if they are distressed, they will tell you that they
are distressed. The problem in prisons is that, far too often,
the staff are not trained; they are not educated sufficiently
to identify problems; the will is sometimes not there to do so;
the emphasis is more often than not on security rather than safety—safety
for people and the emphasis on security for all sorts of other
reasons—and, until that changes in order that relationships
and care can be given to people who are in need and people feel
able to ask for attention, care and support, I think that the
suicide rate will continue to increase.
Q2 Chairman: You did refer specifically
to women and the particularly high suicide rate in women's prisons
this year. Are there different factors at work here comparing
women's to male prisons?
Ms Crook: Yes. The suicide rate
is high amongst men as well and that must not be forgotten or
lost, but I think women in prison face different problems. They
are usually the primary carers of young children and being separated
forcibly from your children must be the most distressing, appalling,
gut-wrenching thing that could possibly happen to anybody. I speak
as a mother. If somebody took me away from my child, I would go
mad I would go wild with anxiety and rage. So, that is certainly
a significant difference. Of course, when they come with backgrounds
where they have been abused, they sometimes come with more problems
than men do and they respond differently. They take out their
anxieties on themselves; they internalise rather than externalise.
These are broad generalisations of course, but they tend to internalise.
Also, I think the way in which the prisons respond to women when
they are exhibiting difficult behaviour is different to the way
in which prisons respond to men. With men, difficult behaviour
is sometimes tolerated—swearing, cussing, being difficult,
a level of that is tolerated. Whereas, with women, it is not and
they are punished more readily and put into segregation or have
privileges taken away. They are punished more readily because
that behaviour is not accepted. There is a discrimination issue
in prisons which they have to face.
Ms Coles: Can I just add something
there because you raised the question of the increasing number
of women's deaths, which was 14 last year, the highest ever recorded.
I do think it is quite important to talk about self-inflicted
deaths rather than suicides because obviously inquest verdicts
vary and of particular concern to us are those cases where it
is quite clear that the death is a desperate cry for help rather
than a determined attempt to end one's own life. We are currently
working with a number of families of women who died last year
and, within those figures, the majority of those women who have
been sent to prison, either on remand or sentenced, were suffering
from mental health problems or from problems with drugs and alcohol.
We are talking about a prison system that was designed for men
and that should be borne in mind and, in particular, a concern
about treating self-harming behaviour as manipulative behaviour
rather than recognising it for the distress that the individual
is in at a time. A number of these deaths have raised real questions
about the quality of medical care available for people in prison
generally—obviously that applies not just to men but for
women as well—and the worry that prison is still being used
as a so-called place of safety for some of the most damaged and
vulnerable people and I think that the idea of remanding people
to prison for psychiatric reports is really quite outrageous and
clearly does raise questions about the need to divert very vulnerable
people from the prison system that does not have the trained staff
or indeed the resources to properly care for them.
Chairman: When we started this session,
Juliet Lyon was trying to get here and I see that she has now
arrived, so I ask that she now comes and sits at the table with
the other witnesses.
Ms Lyon: Please accept my apologies.
I am very sorry.
Q3 Lord Lester of Herne Hill: I am very
interested in trying to look at these problems in a wider context
beyond the United Kingdom and to get some sense of the comparative
position in other European and Commonwealth countries. I have
not seen any data from Australia, Canada, New Zealand, South Africa
and countries of that kind with similar legal systems but I have
seen the data from the Council of Europe about some 41 countries.
I should have declared an interest because I am a long-standing
supporter of the Prison Reform Trust and the Howard League. I
realise that the data I have looked at is just crude statistics.
Indeed, it says that no one has killed themselves or died in a
Scottish Prison at all, which probably means that Scotland has
not put in any data yet. Bearing all that in mind, what comes
out, on a very crude reading of some of the figures, is that the
UK is doing rather badly, especially if you count Northern Ireland
which is eclipsing, per 10,000 prison population, anything in
England and Wales by far. The Republic of Ireland does not come
out too well but, if you look across Europe, Germany and the Netherlands
are much better than we are, both in terms of suicides and death
other than suicide, whereas France is worse than we are, or not
worse but pretty bad. Do any of the NGOs represented today have
any data or studies or information that they could provide the
Committee with to give us a trans-national perspective because,
when we talk about the UK, it is a little parochial if we cannot
ask ourselves questions like, "Why are people not trying
to commit suicide or dying as much in custody in other comparable
countries"? Is this an aspect which any of the NGOs can help
us with, not necessarily today but during the course of our study?
Ms Coles: I think what you have
identified is that there is a lack of readily available information
and we are currently conducting a research project looking at
investigations into custodial deaths and looking at it internationally.
So, we are in the process of collating some of that material which
we can make available.
Q4 Lord Lester of Herne Hill: The particular
point I had in mind was the question as to why, say in the Netherlands,
the situation is so much better than it appears to be even in
England and Wales. Why is it so much worse in Northern Ireland?
Why is it better in Germany? Why is it not better in France? Someone
must have done a PhD on some of that! If we can get any information,
it would certainly help us to get a perspective.
Ms Lyon: I can speak about one
thing in America, if that would be of help. I was an independent
member of the delegation that went from the Prison Service to
investigate human rights observance in relation to suicide prevention
in various American prisons something like two years ago now and
there will be a Prison Service report that might be of use to
this Committee. If I might summarise very quickly, essentially
what we found was that although there was a low level of deaths
by suicide in the American prisons, their breach of any kind of
semblance of human rights observations is quite breathtaking.
It seemed to us that anything would do to prevent a death in that
institution and that "anything" could, at its most extreme,
mean someone, for example, who we saw to be held in a cell which
just simply had a grate in the floor; it had glass walls; the
person did not have any clothes; it was like a very old-fashioned
zoo. That was the worst extreme but there were various gradations
of that kind of deprivation of any means by which people could
kill themselves. It seemed to me that the people were spiritually
dead but physically still alive and statistically still alive,
which seemed to be the point. I am sorry if that sounds cynical.
I think there have been studies about the number of deaths following
custody in the States and I am sure that there is research in
America that might be useful to the Committee.
Q5 Lord Lester of Herne Hill: Just so
that you have the figures, 14 deaths per 10,000 for England and
Wales; 41 for Northern Ireland—those are the figures I have
here; in the Netherlands, only 7.7; in Germany, only 9.9; and,
in France, 24. If you add Northern Ireland to England and Wales,
you end up with 55, which is by far the largest total figure if
these figures are in any way reliable.
Ms Crook: Can I just say that
the Northern Ireland figures are a little odd because there has
only been one self-inflicted death that I know of in the last
two or three years.
Q6 Lord Lester of Herne Hill: For deaths
other than suicide, it shows ten per 10,000 for England and Wales
and 20 for Northern Ireland.
Ms Crook: That may well be true
because there may have been murders inside prisons, but the suicide
rate in Northern Ireland is something that the Northern Ireland
Service is taking more seriously now because they did have a suicide
and they had no policies or work on it, but they are now developing
that. We did a study in Northern Ireland where we issued a consultation
to every prisoner in the whole of Northern Ireland on one day
to ask them what they would like in order to prevent suicides,
to feel happier about their time, a type of crisis intervention,
so the Northern Ireland Service is doing is best to try and prevent
further deaths and I think that the figures are a little odd.
Q7 Lord Lester of Herne Hill: The figure
in the Irish Republic is the same as England and Wales, 14 per
10,000.
Ms Crook: I do not know about
the Republic; we have only done work in the North. I will certainly
give you a copy of our report on Northern Ireland.
Q8 Mr Shepherd: And your recollection
was that there have been only two deaths in the last two years?
Ms Crook: My recollection—and
I may be wrong and I will certainly correct it if it is wrong—is
that there has only been one.
Chairman: I am sure we can establish
what the figures are and perhaps move on now.
Q9 Lord Campbell of Alloway: Using Lord
Lester's narrative as the base as it seems to me that the figures
he gave are broadly accepted, is there any way—I do not
know anything about the Prison Service—that one can identify
the factor or the factors that are missing which fail, as he puts
it and you agree, to make things better? We are using the term
"to make things better". To somebody who has no expertise
in this, I would like to know if you can identify what these factors
are that are missing in our regime. Do I make myself clear?
Mr Solomon: I think that is an
important question but that, first of all, you need to look at
the use of imprisonment and especially for the mentally ill and
particularly for women who should be diverted to other secure
mental health services who are ending up in prison because of
the lack of places in those centres, and the fact that the use
of prison for women has risen, those who commit minor offences
and motoring offences, which was clearly demonstrated in a report
that was published last week. So, why I think it is important
to focus on the conditions and the way in which people are dealt
with, I think we should not also lose sight of the way in which
the use of imprisonment has changed and it could be that has coincided
with the high rates of suicide.
Q10 Lord Campbell of Alloway: It must
be, surely, to do with the regime of the prison.
Mr Solomon: Of course.
Q11 Lord Campbell of Alloway: It must
be endemic somehow. I fully understand the terrible position of
separating a woman from her children. I quite take that point.
That is not 100% or 90% of the problem here. There must be a larger
relationship when one comes to the problems of all sorts of other
circumstances. Can you identify what is missing? I am not trying
to be tiresome, I just do not understand.
Ms Crook: I think it is a fundamental
question. I think it is not about providing services, it is about
relationships. Whilst of course we would all agree that services
should be improved, that there ought to be more education, more
activities, that people ought to get out of cells more, that must
be done as a fundamental. It is about relationships. This Committee,
dealing with human rights, in one of the other articles is the
right to respect the family life, for example. If you only get
to see your family and your loved ones once every two weeks for
an hour maybe in a crowded room with a lot of noise going on and
you cannot get up to buy them a cup of tea, that they have to
go up and buy you a cup of tea, that is not a good relationship
that you are having with your wife. It is not a good relationship
that you are having with the staff who are imposing on you that
relationship with your partner. I think the first thing is that
the prisons' concentration and obsession with security at the
cost of forming good relationships and support for the people
is the most important thing in the prisons and it has to change
and, if there was going to be one thing, that is what I would
stress.
Ms Shaw: May I just add one small
point to that. I think that where all the NGOs here have identified
particular conditions that have led to people's deaths, one of
the things that we have identified as an organisation throughout
the years of our work is that, at inquest after inquest, the same
factors arise in terms of people's level of risk, open ligature
points in the cells, poor detoxification regimes, all sorts of
issues. Yet, that gets translated into policies around suicide
prevention and yet we have heard prison officer after prison officer
answer questions to say that they have not had refresher training
on the implementation of some very good guidance that the Prison
Service has issued, and our sense of what is going on is that
there is no proper system for ensuring that there is learning
from deaths that occur in similar situations.
Q12 Lord Campbell of Alloway: How does
one make the system proper? Should there be some sort of relationship
with Social Services—is that missing?—that should
be improved? How does one make it better? What is missing that
is proper?
Ms Lyon: One of the things that
the Prison Service does is to bring in in-reach mental health
teams in an effort to try and improve general attention to mental
health issues and, in particular, to people who are at risk of
suicide. I think one of the issues is that the Prison Service
has a culture of observation and control. It is a disciplined
service. If it feels that someone is at risk of suicide, then
a form is raised and that person is observed and the time in between
observation is reduced if the person is seen to be very much at
risk. This was a culture that, years ago, pertained in psychiatric
hospitals and was done away probably in the late 1960s and early
1970s when there was a realisation that actually what people needed
was to be near somebody, to have some comfort, to have a person
to talk to and to have contact. That is very much an anathema
still in the Service. Although the Service wants to respond, there
is no doubt about that—although there may be individual
instances of cruelty—what I am saying is that the culture
itself is not conducive to looking after people who are at risk
of suicide. I very much support what people here have said about
diversion of the mentally ill away from the Prison setting. One
could go on trying to improve the setting and that is obviously
worthy, but the fact is that diversion really is paramount.
Mr Stinchcombe: As I understand it, there
is already quite a lot of evidence available as, to the principle
indicators of the most vulnerable groups, whether they have drug
problems, whether they have mental health problems, their age
group, their sentence and whether they are on remand or whatever.
Presumably, if one were doing a comparative analysis with other
nations, one could see what parts of their prison regimes were
different and relate it to different suicide rates. For example,
one could compare prison level population; one could compare the
amount of mental health treatment available; one could compare
whether there were conjugal visits or whatever and then assess
comparative suicide rates? Is anybody aware of whether that work
has been carried out by anyone?
Chairman: I think the answer is "no".
Lord Campbell of Alloway: It would lead
to a remedial approach if we could get it. What Paul Stinchcombe
has just said is really what I said but said better! If you take
that approach, then you can start a remedial process but, until
we get that approach, it is awfully difficult to know what to
do.
Chairman: It is something that we will
obviously have to return to during the course of this inquiry.
Q13 Lord Judd: I have a couple of questions
arising out of what you have been saying already. First of all,
would you say that the issue we are dealing with here is symptomatic
of a more general problem in prisons about a general culture of
what prison is about and what its objectives are and that, if
this were clear, it would be a more receptive environment into
which special needs, such as those who are in some kind of jeopardy
in the mental context, could be taken more seriously? In relation
to that, as far as the immediate situation is concerned, how far
do you think those responsible for sentencing really understand
the risks and dangers to which they are exposing people in the
system?
Ms Coles: I think the short answer
is that they do not understand the nature of some of the institutions
that they are sending people to and also I think you are absolutely
right to say that you cannot look at deaths in prison in isolation
from other factors such as sentencing and such as the regimes
operating in some of the prison establishments, and you only need
to read some of the Prison Inspectorate reports on some of the
institutions to get a very good sense about what it is that we
are actually sending some of the most vulnerable and damaged people
to and, in particular, I know that a matter of concern to us of
all around the table is the situation for young people and juveniles.
What comes out of the Prison Inspectorate reports and what comes
out of the inquests into those deaths about what the reality of
life in prison for those children and young people has actually
been is absolutely shocking.
Mr Solomon: Can I just mention
some very important research which is being done by Alison Liebling
at Cambridge University that the Committee may well be aware of.
She has been doing some research looking at a number of the issues
we have already talked about in relation to 12 prisons. One of
her emerging findings is that the fundamental issue is the relationship
between prisoners and staff and that there needs to be much more
of a focus on promoting well being. When we talk about well being,
what we mean is the treatment, the respect, the level of justice
that is allocated to prisoners in relation to disputes, the distribution
of power in the prison and the level of family contact. There
needs to be far more focus on well being rather than on control,
containment and risk and that, where prisons have begun to move
towards that in relation to prison staff relationships and focus
on that, there has been, from here initial research, an impact
on the levels of suicide.
Q14 Chairman: What is so special about
the first month in prison? Fifty-four per cent of the total figures
of self-inflicted death occur in the first month. Is it something
about the shock of being in prison or is it that people who are
judged to be at risk are remanded in custody rather than being
granted bail?
Ms Crook: "Yes" to all
of those.
Ms Lyon: One of the things that
the Safer Custody Unit has done is to try and concentrate on reception
arrangements when it became aware that these were when the deaths
occurred, but the fact is that because—and I am sure you
have talked about this already—of the level of overcrowding
and short staffing in a number of places, entering that kind of
establishment with very little feeling of anybody who might care
for you is still a great shock. At some prisons, there is the
First Night in Custody Scheme—there is one of those run
by PACT in Holloway Prison, for example—and that seems to
be good practice where a voluntary organisation working alongside
the Prison Service makes absolutely sure that, within the first
few hours of somebody arriving in the prison, they are seen and
that their concerns are paid attention to. What has happened to
my children? I do not know where they are. I have locked my dog
in a shed. There are so many things that people arrive with. I
think it is perhaps surprising that so few people expect to be
sent down when they arrive in court. Those immediate concerns,
often the guilt and shame of what they have done and the lack
of contact with people and then the lack of reception arrangements
in the prison combine to make it a very, very dangerous and risky
time.
Q15 Mr McNamara: I wonder if I could
go on to look at the actual position of prisoners and when they
go into prison. You spoke about the effect of women and children
but, of the number of women suicides there have been, how many
in fact did have dependent children?
Ms Crook: I cannot tell you that
but I can find out.
Q16 Mr McNamara: I think that is an important
point in relation to what you were saying.
Ms Crook: We did some research
by asking women who had deliberately self harmed and who had attempted
suicide and the majority of those had young children. I cannot
tell you about the successful suicides.
Q17 Mr McNamara: Among the figures that
we have is that 95% of young prisoners between 15 and 21 suffer
from a mental disorder and 80% have at least two and then we go
on to all the different types of things that we have. We find
that 20% of male and 37% of female sentenced prisoners had previously
attempted suicide. The 10% of female sentenced young offenders
reported having been admitted to a mental hospital at some point.
It seems that prisoners are arriving after sentence at the prison
with no registering of mental disorders of one sort or another.
What more do you think can be done in practical terms to prevent
those prisoners trying to commit suicide or in fact to harm themselves
in other ways? That is my first point. My second point is, given
these figures that we have for the mental disorientation disorders,
psychoses, neuroses and all these other quite alarming figures
which make the prison population very different from the rest
of the natural population, is sending people with those sort of
mental disorders to prison to a punitive regime the right way
of dealing with them and, if we say "no", where do we
draw the line between those for whom you say that a degree of
disorder perhaps might merit some punishment but that other disorders
show that a person really should not be in a prison but should
be in a hospital of some sort?
Mr Solomon: A very simple thing
that could be done, from having spent the morning at a big London
local prison and speaking to staff there, is the issue of data
transfer. It was pointed out to me by staff who work on reception
at this prison that, more often than not, basic information about
a prisoner's medical background and about their background in
relation to substance abuse does not arrive when they arrive at
the prison and, if there is not time because they are arriving
late from court to do full medical assessments and the information
does not arrive, it is very difficult to know the level of vulnerability
and the level of risk that that prisoner might have. So, there
is a very simple issue there about data transfer and how it is
shared through the criminal justice agencies.
Q18 Lord Campbell of Alloway: Is that
because of the Data Protection Act?
Mr Solomon: No, it is simply because
the criminal justice agencies do not talk to each other very well
and are unable to share basic information electronically and it
can be a matter of weeks, if one prisoner is transferred from
another prison, before crucial information arrives which should
have been there when they arrived at the prison.
Q19 Lord Judd: Are you convinced that
those responsible for sentencing are adequately apprised of all
this information themselves?
Mr Solomon: No, but that is a
separate issue.
Ms Coles: If they are, they choose
to ignore it. I think there have been a number of cases, some
quite high-profile cases involving children, where judges were
well aware of the high risk of suicide and self harm that those
young people presented but chose to ignore it and sent them to
establishments knowing that it was impossible for the prison staff
to properly care for those young people given the high levels
of disturbance that they presented.
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