Joint Committee On Human Rights Minutes of Evidence

Examination of Witnesses (Questions 131 - 139)



  Q131  Chairman: Welcome to this meeting of the Joint Committee on Human Rights. Ms Corlett and Mr Foster, you are respectively the policy director and the principal solicitor of Mind. Is that right?

  Ms Corlett: That is right.

  Q132  Chairman: You have submitted written evidence to us for which we are very grateful and you will no doubt have followed from a distance the progress of the inquiry to date. Looking at your evidence, when we consider deaths which arise apparently from control and restraint, are you suggesting that the existing guidelines are satisfactory if they are properly implemented?

  Ms Corlett: We do not have a great deal of expertise about control and restraint guidelines within the prison service but within mental health settings our experience is that the guidelines in themselves are satisfactory; it is the implementation of the Guidelines which is at fault. That appears to be partly to do with training, partly to do with individual practice and partly to do with the monitoring and assessment of use. That is where things seem to be falling down.

  Q133  Chairman: You would say it was a management and information and training issue; it is not that the guidelines themselves do not have legislative force?

    Ms Corlett: It is a problem that the guidelines appear not to have legislative force. Our view would be that guidelines are there to be followed and if people go beyond guidelines that ought to be considered an assault on an individual. The guidelines are quite sufficient and we do not have particularly any evidence or indications that they have not been sufficient. Our indications appear to mean that they have not been followed.

  Q134  Chairman: You will know—it is a matter of public record—that there is a disproportionately high rate of deaths of ethnic minority patients in psychiatric care or at least custody in relation to control and restraint. Is this explained by the disproportionate hospitalisation of people from ethnic minorities or do you think there are some other factors at work here?

  Ms Corlett: It clearly is to do with the increased hospitalisation of people from ethnic communities. The fact that there are more people in the system is going to affect the number of statistics of people affected by the system, but even so there seems to be plenty of evidence that response within the system towards people, particularly Afro-Caribbean people, is much more likely to be aggressive and invasive. The Department of Health's own action currently in their piece of work to develop a framework to work with black and ethnic minority communities reflects their acknowledgement of that. The indications that we have in the report that is coming out on Thursday of the inquiry into the death of David Bennett also appear to indicate an acknowledgement of a level of institutional racism. As well, we already have it as a matter of record from different inquiries about the perceptions of people, particularly again young black men, that they are perceived as being more dangerous. The fact that people may be larger is considered to be a more dangerous factor and therefore responses tend to be more aggressive, more likely to be control with medication or physical means.

  Q135  Chairman: We have had written evidence which would suggest that there are occasions when it either could be or is the case that mental distress is misunderstood or misinterpreted as aggression. To what degree do you think there is training amongst police custody officers and the prison service staff about mental illness and the way it can present?

  Ms Corlett: There seems to be very little training about mental illness or the way it can present. In particular, we know of research by NACRO that prison staff tend to identify people by their overt behaviour, which means that where individuals are distressed but their distress is perhaps more passive, in the sense that people may be withdrawn, that is not recognised. Where suicides are preceded by people being withdrawn, they tend not to be noticed, so that is one of the things that we are aware of.

  Mr Foster: This came out of the inquest into the death of Roger Sylvester, particularly in relation to the police. I know you have already received evidence from INQUEST that touches on this. We know the Metropolitan Police have indicated they are getting better since the death of Roger Sylvester—this came out during the inquest—in particular with the introduction of CCTV in cells and the training of custody sergeants. It remains to be seen the extent to which this is more than words and is being applied on the ground. It is probably rather too early to tell at the moment. It is helpful to know the Metropolitan Police have recognised the shortcomings prior to that point.

  Q136  Chairman: Would you say that education and training alone would be sufficient to change the way in which control and restraint were used?

  Ms Corlett: Education is clearly very important, particularly education in de-escalation techniques for violence on a ward or in a prison. That is central, but we have evidence firstly that some of the training people are receiving, even in mental health settings, is not necessarily of that type. I have anecdotal evidence of people within mental health settings being given restraint training which relies on the use of pain rather than on de-escalation techniques. Clearly, even training can go on the wrong track. Also, there is a bigger issue about educating the system and where a system is untherapeutic, where space is limited, where there is overcrowding, where staff turnover is very quick, whether in mental health or in any other setting, violent situations are much more likely to occur. Educating the individual is only one part of the overall picture.

  Q137  Lord Lester of Herne Hill: I know that the Home Office has been worried for many years about the fact that black people are disproportionately heavily sentenced, refused bail and so on within the criminal justice system. This is another aspect. Has there been any concluded study of the extent to which race prejudice is affecting decisions to impose control and restraint disproportionately against black prisoners, patients or detainees and, if so, could you provide it for us, please?

  Mr Foster: There are two parts to the answer. First, yes, there is information out there. There is a recent report called Inside Outside and before that there was Breaking the Circles, which you will know a lot more about than I do. Secondly, the extent to which this is now informing practice. I do not think we are really qualified to say. We would like to think it is. You will be aware of the discussions about Professor Sashidaran last year, about the implementation and the take-up of the report Inside Outside and the extent to which that has been applied in practice and adopted by the Department of Health.

  Q138  Lord Lester of Herne Hill: Has the CRE done anything about it?

  Ms Corlett: The CRE, as I understand it, have been involved to some extent in discussions with the Department of Health but to a disappointingly small degree. There has been some frustration about the level of communication between the Department of Health and the CRE in the development of these most recent proposals.

  Q139  Lord Judd: Administration of medication is a controversial issue. Are you at all concerned that the way this is pursued may sometimes infringe the human rights of those receiving it? If you are concerned, why is it happening and what can be done to put it right?

  Mr Foster: The short answer is yes, we are concerned. Yes, in the broadest sense, depending on what you mean by excessive administration, there comes a point at which it must be violating one's rights to autonomy and choice. In a narrow sense, if you are talking about the violation of any of the Articles of the European Convention, there has been a succession of cases limiting the effectiveness of Article 3 of the Convention, inhuman and degrading treatment, effectively making it very hard to challenge levels of medication. The causes of excessive administration relate back to the perception of dangerousness. There does seem to be an excessive use of not just high levels of medication but also polypharmacy—i.e., mixing of drugs from the same class which is dangerous practice at best, for those who are seen as being dangerous, rather than on the acuteness of presentation. Often it is based upon how somebody has been in the past, somebody's previous behaviour, previous prescribing practice, rather than the needs at the moment. In terms of staff being helped to end such practices, there is plenty of information around. The Royal College of Psychiatrists has issued guidelines. The Mind position, along with the Mental Health Alliance, is that there should be something in the proposed legislation when the report on the Mental Health Act comes forward to address this on a statutory footing, possibly in line with the New South Wales Act in Australia.

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