Examination of Witnesses (Questions 160
MONDAY 9 FEBRUARY 2004
Q160 Chairman: It is evident from
the evidence we have had so far that there is a failure on occasion
to pass on prisoners' medical information on reception in prisons.
Do you have any comments about the failure in handing on of the
records and any evidence about whether this problem is widespread?
Mr Foster: We are aware of the
problem. We do not see it at the prison level but we have plenty
of information from people or families writing or contacting us
to say that the prison does not seem to know about my son or my
daughter's mental illness. There are any number of reasons that
may contribute towards this. Some prisoners may choose not to
pass information on about their own mental health if they do not
think it is relevant. There is a civil rights issue there and
how do you balance that with the need to protect people. More
commonly however, if there is a relevant mental health problem,
it is available through the court system and in reports. There
seems to be a great lack of liaison coming through from the court
system. I know this is something that the government is aware
of but it certainly has not bedded down yet. Families tell us
that they have information but that they are not encouraged to
bring the information forward or to discuss it. Within the prison,
again you have the prison ward staff on the one hand and the increased
use of the National Health Service coming in by way of in-reach
to prison on the other. To some extent, there is an issue of who
manages the information; who is in charge at that point. We have
information about tension between the primary care trust, which
provides the NHS in-reach, and the prison staff who understandably
think this is their information because they are their prisoners.
All of these are factors that contribute. I do not think we are
qualified to say whether one is more important than another.
Q161 Chairman: What about mental
health screening in prisons?
Mr Foster: In theory, there should
be a screening that takes place at the early point of reception,
with an assessment and then that leads on to transfer. I believe
the target figure is three months, which is still a long time
for somebody with a significant mental health problem. Even that
three month figure is not being hit, and it is started by the
assessment so if the assessment does not happen at an early stage,
or at all, then it is not picked up. Unless a prison has had previous
contact with mental health services or is showing signs of distress,
the distress may not be noticed. Services may not be offered and
it comes back again to training and education for the staff concerned.
Ms Corlett: There was quite a
distressing case recently of a 16 year old, Joseph Scholes, who
went into a young offenders' institution. He had been recommended
to go to local authority secure accommodation but instead, because
of his mental distress and background, he went into a young offenders'
institution. His mother pointed out he had been raped in the past
and that was a difficult situation for him. He was assessed when
he came in. He had self-harmed all over his face very recently
and had the scars still there. I gather that he was asked if he
self-harmed and he said no. That was taken at face value. He was
put initially in a particular type of reception cell but was then
transferred into a cell on his own with no suicide watch and ligature
points. Effectively, he was very poorly cared for when all the
information had been available both visual, from his mother directly,
verbally, and written from the court. None of that was acted on.
It is difficult to understand how all of that information could
have been ignored and yet it was.
Q162 Mr Shepherd: I know from my
own probation and legal service that there is extraordinary difficulty
in getting medical reports within prisons. That is repeated by
the doctors that have to serve these institutions themselves and
there is an extraordinary degree of frustration as to knowing
the medical history of the patient concerned. It is often cited
that the Data Protection Act is an inhibition in this. Have you
encountered that argument?
Mr Foster: We have certainly heard
of the argument. Most famously, it hit the press recently in the
case of Humberside Police. The Data Protection Act, as I understand
it, does not prevent anything from happening that is otherwise
lawful. It is really to do with regulating how disclosure and
sharing of information should take place. If therefore someone
has the right to keep information confidential, the Data Protection
Act does not of itself require disclosure of that. However, there
are all sorts of ways at common law and in decided cases whereby
information can be disclosed without the person's explicit consent.
If it would be helpful to the Committee, we can certainly pass
that through in writing. In other words, the Data Protection Act
is used as a screen to hide behind quite often and I would suggest
that is largely to do with the misunderstanding of how the Act
Q163 Mr Shepherd: I would be grateful
for a note on that. It arises from particular constituency circumstances.
In the case that I am particularly thinking about, there is a
question of diagnosis and this is often a very muddy area between
severe personality disorder and schizophrenia. It puts vulnerable
people at particular risk if they are categorised as having a
severe personality disorder rather than schizophrenia. How do
we get this diagnosis? I know it is not an absolute but how does
this need sharpening up?
Ms Corlett: We are neither of
us clinicians. I think you would have to talk to the medical profession
Mr Foster: I do not think they
Q164 Mr Shepherd: It is a frustration
for families and parents.
Mr Foster: Absolutely. It is something
that Mind encounters a great deal. We hear it from individuals
who are fed up with being diagnosed and rediagnosed, and families.
Sometimes there is a suspicion. I certainly heard of one person
who was detained as having a mental illness. She got into the
ward and was apparently more trouble than the ward anticipated,
so she was hastily reclassified as having an untreatable personality
disorder and booted out that same night. One wonders whether this
was on medical or management grounds.
Q165 Chairman: What difference would
you say the Human Rights Act has made in relation to the treatment
of mentally ill people in detention?
Mr Foster: We have had a long
discussion about this. I think our view is that the Human Rights
Act in itself has not made any difference because it is still
down to education and processes. What is needed is a change to
the mind-set, to bring it into line with the Human Rights Act.
I have mentioned the case of Munjaz, which came as something
of a shock to hospitals which were used to doing their own thing.
We have had this a lot in terms of people getting discharged from
hospital and section by a mental health tribunal. The hearings
are plagued by delays and cancellations. This is immensely distressing
and anti-therapeutic for the person concerned. They get themselves
geared up for a hearing and suddenly they are told there is no
psychiatrist to sit on the panel and the hearing goes off. There
have been Human Rights Act cases which have said that this is
unlawful and should not happen, and compensation can be paid in
some circumstances. In other words, having cases going against
the trust or prison or police service concerned concentrates the
mind more than the mere words of the Human Rights Act.
Q166 Chairman: What you are saying
really is that for the Human Rights Act to have an effect on people
in this situation there does need to be more training and awareness.
Mr Foster: Training and, I am
sorry to say, challenges using the Human Rights Act to make a
point. If a trust knows it is going to be effectively fined for
breaches, that is a great incentive to moving on the procedures
and bringing them into line. It is a shame to put it in those
Q167 Chairman: Thank you both very
much for coming here today to help us with this inquiry into an
increasingly serious issue.
Ms Corlett: There have been a
number of things which we have been unable to cover. Would it
be helpful to send those in?
Chairman: It would be extremely helpful
and we would be very grateful.