Joint Committee On Human Rights Minutes of Evidence

Examination of Witnesses (Questions 140 - 159)



  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 administered—to black men— Afro-Caribbean men specifically. That is a specific problem.

  Q141  Lord Judd: Can you say anything about why?

  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 health problems?

  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, parallel system.

  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 ask—I am sure my colleagues would as well—is 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, likewise.

  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 pre-history?

  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.

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Prepared 17 December 2004