Examination of Witnesses (Questions 140
MONDAY 9 FEBRUARY 2004
Q140 Lord Judd: You mentioned that
there are samples of Afro-Caribbean people dying after medication.
Is there a disproportionate problem with this ethnic minority?
Ms Corlett: I can send you the
evidence afterwards but we think the evidence is that higher doses
of medication are administeredto black men Afro-Caribbean
men specifically. That is a specific problem.
Q141 Lord Judd: Can you say anything
Ms Corlett: It appears in the
reports Inside Outside, Breaking the Circles of Fear and
the new delivery of race equality from the Department of Health
and their reports on trying to address this issue of racism within
the health service have indicated some of this. It appears to
be down to perceptions, misunderstanding of culture to some extent,
which is more likely to see something which may merely be cultural
as psychosis. The fact that people talk to themselves may be a
cultural thing. It is judged as psychosis. There is a greater
diagnosis of illness, number one, but also people appear to see
someone who is bigger needing a higher dose, to excessive rates,
and also somebody who is black as being more dangerous and therefore
needing higher doses to be used as a restraint. Research related
to race has indicated that where there are staffing shortages,
where there are other issues that mean people are fearing violence
generally, not specifically related to that individual, there
may be a higher level of violence and dosages increase.
Q142 Lord Judd: Would you suggest
that training and education could go a longer way to getting all
this put right?
Ms Corlett: Training and education
could clearly go a long way to getting all this right but there
needs to be a very clear statutory foundation for that as well.
There should be absolutely no reason why somebody should go over
a BNF maximum. Going over that should make an individual accountable.
Mr Foster: There is clear evidence
that increasing the dosage beyond a certain point has no particular
beneficial effect in terms of addressing the illness but it may
have a side effect on the person concerned.
Q143 Mr Stinchcombe: If I can declare
an interest, I am a trustee of Wellingborough Mind. Does Mind
have a view as to whether those with serious mental health problems
should ever go to prison?
Ms Corlett: If you are seriously
ill to the extent that in any other circumstances you should be
in hospital, then absolutely you should not be in prison.
Q144 Mr Stinchcombe: Where do we
draw the line at seriousness?
Ms Corlett: In the same way that
you would draw the line at seriousness for somebody in the community.
Q145 Mr Stinchcombe: What are the
consequences of holding in prison people with those serious mental
Ms Corlett: From the evidence,
it appears that they become more ill and it would appear that
people who have less severe mental health problems in prison develop
more severe mental health problems. Prison appears to be a good
greenhouse for developing mental health problems.
Q146 Mr Stinchcombe: Are prison staff
adequately trained to be able to deal with those kinds of consequences
and those kinds of would be patients?
Ms Corlett: No.
Q147 Mr Stinchcombe: Do you agree
with Ann Owers that we need a new generation of institution to
accommodate people with those kinds of problems?
Ms Corlett: It is difficult to
have a very clear view on this. Our view is that if people seriously
should be in hospital, a secure hospital if that is necessary,
then prison in itself is not a therapeutic environment. People
who are in prison are liable to develop mental health problems.
Therefore, it appears to us that the answer is to address that
within the prison system rather than to develop an additional,
Q148 Mr Stinchcombe: Can I ask about
certain prisoners with less serious mental health problems? For
example, a former constituent of mine in Wellingborough Prison
was sentenced to prison having set fire to some curtains in a
church in the week when both his parents died. He ended up with
a discretionary life sentence, serving 25 years. Does Mind have
any comment as to how we could deal with the kind of problems
possessed by that person in those circumstances, without institutionalising
him in custody?
Ms Corlett: It seems very odd
that such a person should be sent to prison at all. I cannot understand
why a non-custodial sentence would not have been more appropriate.
Mr Foster: I was looking at the
most recent statistics from the Department of Health. Most people
reckon that about 70 per cent of the prison population have some
form of mental disorder which, on the present figures, would be
about 50,000 people. It is very noticeable that the number of
transfers from prison to hospital are down to about 500 a year.
That figure has gone down in the last 10 years. It seems to me
that the machinery is there. It is not being used properly and
the question that I would certainly askI am sure my colleagues
would as wellis why is not more use being made of hospital
disposals, both at the point of sentence and at the point of transfer.
We know the answer is to do with bed shortages but that is where
the problem is, I would suggest.
Q149 Mr Stinchcombe: I do not know
whether you have any view as to whether we will find useful information
from those people who self-harm in custody with mental health
problems and whether we will be able to draw any inferences from
their experiences about those who have committed suicide, who
we cannot question.
Ms Corlett: There is a link between
self-harm and suicide. Those who self-harm are more likely to
commit suicide. It would be interesting to look more closely at
the increase in self-harm within the prison population or the
increase in self-harm amongst people who go into prison as an
indication of the level of mental distress more generally. Whether
you can make direct links between that and suicide I do not know
but there is certainly a link, if not a direct one.
Q150 Lord Campbell of Alloway: You
mentioned guidelines under the Mental Health Act. You said that
the implementation with training and education was a crucial aspect
and that the guidelines as such were satisfactory as having no
legal effect, although they are subject to the ECHR, of course.
Mr Foster: Yes. There was quite
an important court case last year which established that the mental
health code of practice which lays down the guidelines in the
psychiatric system should be followed unless there are exceptional
circumstances to depart from it. It still finishes up though with
a code of practice at a lower level of enforceability than prison
rules and we have been concerned about the discrepancy between
those two. I apologise for interrupting.
Q151 Lord Campbell of Alloway: That
is exactly what I am after, the level of enforceability. They
have not the same level of enforceability as prison rules. They
certainly have not the same level of enforceability as a statute.
What is the level of enforceability?
Mr Foster: It is a very moot point.
You will be hearing evidence later on from the Mental Health Act
Commission who will have more to say about this. Mind intervened
in the case of the Crown on the application of Munjaz v The
Mersey Care Trust and, briefly, the Court of Appeal came to
the conclusion that the code of practice should be followed unless
an exception could be made for an individual prisoner. Therefore,
a blanket decision as applied in that particular case to Ashworth
High Secure Hospital to depart from the code of practice guidelines
was per se unlawful and they had to reconsider their patients
one by one. I believe that case may be under appeal at the moment.
Q152 Lord Campbell of Alloway: I
think it is. If a suicide happens in prison, does not the Coroner
come along to carry out an inquest?
Mr Foster: Absolutely. Mind gave
evidence to the full inquiry into the certification of deaths
last year. There is quite a lot of movement in that direction.
The problem is the lack of joined-up thinking within the system
between the Coroner's inquest, which is essentially focusing on
the narrow cause of death although they have relaxed to
some extent the internal inquiry within the hospital and
any redress for the families. The difficulty with coming up with
a verdict of suicide in the Coroner's Court is that this often
does not disclose the systemic failings which led to information
not being passed on. I can think of several occasions when I have
talked to family members who say that on the day the ward staff
say they did not know that the person was suicidal; but if they
had looked back over the previous few months, if they had looked
at the admission criteria and the admission records, they would
have spotted the danger signs. If they had talked to the families,
Q153 Lord Campbell of Alloway: What
is the drill? A chap dies by suicide. Do the prison staff get
together under some sort of supervision and work out what they
think? Is that then told to the Coroner or does the Coroner make
his verdict beforehand? How does it work?
Mr Foster: To the best of my knowledge,
we have no specialist expertise about what happens within the
prison, but under the normal Coroner system the Coroner's Officer
will make it his or her business to gather evidence for the sake
of the inquiry. I would normally expect reports to be available
from the prison or the setting where the person is being detained.
If the prison staff say something and there is a record to that
effect, that is more or less the end of it in terms of reporting
facts. It is very hard for anybody else to disagree about that.
The real problem with the Coroner's report is not being able to
stand back and look at the chain of events in the broadest sense
and the failures in the system over many weeks, which have led
to that point.
Q154 Lord Campbell of Alloway: You
cannot do better than have the prison staff. Nobody else is going
to know much more, are they?
Mr Foster: That is correct.
Q155 Lord Campbell of Alloway: Can
you give the assurance that by and large, if a man commits suicide,
the prison staff do give an account to the Coroner of the relevant
Mr Foster: That is correct. There
was a case which Committee members may be aware of, the case of
Keenan v the United Kingdom, on exactly this point. It
was a suicide within prison and the issue was about somebody with
schizophrenia. What was the person doing there? Had they been
receiving adequate medical attention? Were they going to be suicidal?
The European Court of Human Rights came to the conclusion that
although the person was not known to be suicidal, nevertheless
there should have been some treatment available for their illness
of a specialist nature.
Q156 Lord Campbell of Alloway: You
did say there should be a statutory foundation. Why, if the drill
is very much as decided under the case to which you refer? Is
it not all right as it is?
Ms Corlett: Is that for medication?
Q157 Lord Campbell of Alloway: Yes.
Ms Corlett: If at the moment the
only redress is when somebody ends up in a Coroner's Court, that
is rather too late. There should be a statutory foundation to
protect people from excessive administration of drugs at any point
within the system.
Q158 Lord Campbell of Alloway: I
suppose it is more the pre-history which goes to the Coroner's
Court. There should be a statutory foundation?
Ms Corlett: We believe it should
not be lawful to administer doses above the maximum recommended
within the British National Formulary Guidelines. Those maxima
are quite high and very often well above the recommended dose,
so there should be absolutely no reason why anyone should have
to go above those maxima and yet those maxima are exceeded often.
Q159 Lord Campbell of Alloway: It
is limited to medication?
Ms Corlett: I think that was related
to a medication question, yes.