Examination of Witnesses (Questions 131
MONDAY 9 FEBRUARY 2004
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
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 knowit
is a matter of public recordthat 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
Sylvesterthis came out during the inquestin 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 polypharmacyi.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.