Joint Committee On Human Rights Minutes of Evidence

Examination of Witnesses (Questions 200 - 219)



  Q200  Chairman: Are you satisfied that the current level of training for the use of control and restraint is sufficient for staff?

  Dr Ladyman: In mental health environments, in prison environments or in both?

  Q201  Chairman: Both.

  Dr Ladyman: We can always do more training. Let me put that as a caveat first of all. We can never train fully enough; we can never train widely enough; we can never do enough to make sure that people understand what their rights and responsibilities are in these situations. Certainly in the mental health environment, I think, yes. In the prison healthcare system, I think we will have to provide more resources and training in that environment than perhaps we have at the moment, but those are only instincts that I have. I do not have a major cause for concern in either area.

  Q202  Lord Lester of Herne Hill: Minister, we have had evidence expressing quite strong concern about the disproportionate or excessive use of control or restraint against members of ethnic minority groups. I am sure you are aware of this concern yourself. Has your department taken any effective steps to investigate these cases?

  Dr Ladyman: I have to say that we have no data one way or the other to suggest that restraint is used more heavily against ethnic minorities than anybody else. There is certainly some evidence that there is a preponderance of people from ethnic minorities that are detained under the Mental Health Act, so there is a greater proportion of people from ethnic minorities detained in the first place and so that might skew the broad data in terms of the broad numbers that are restrained, but we have no evidence at this time to suggest one way or another that the greater proportion of those that are detained are subjected to restraints if they come from those minority backgrounds. I think it is an area in which we will have to do some more research and it is something that we have to keep our eyes open about. We have some work going on by Professor Louis Appleby that might inform us in this area in the future, but we have no hard evidence of that at this time.

  Q203  Lord Lester of Herne Hill: I am sure you are aware from your Home Office colleagues that there is quite strong evidence that black people suffer disproportionately in the criminal justice system from bail to sentence and so on. You have no reason to think that that would not apply also to the excessive use of force and restraint in this area. Would it not be quite useful to have really comprehensive statistics on death in mental health detention, especially looking at the racial dimension?

  Dr Ladyman: As a general principle, you can never have too much information and, yes, I do accept entirely that people from minority ethnic communities suffer unduly in being involved in the criminal justice system and I have acknowledged that a greater proportion of them are detained under the mental health legislation as well. What I do not have hard data about at this time is whether a greater proportion of those who are detained suffer restraint and isolation and such techniques as part of the process of controlling their behaviour when they are detained and that is something about which I think we could do with some more information.

  Q204  Lord Lester of Herne Hill: Our concern is with racial stereotyping and profiling but this is something you are going to look into?

  Dr Ladyman: Yes.

  Q205  Lord Judd: I would like you to comment in terms of Convention human rights on two aspects. One is seclusion and one is medication. On seclusion, you have said that action has been taken to make seclusion safer, but how satisfied are you that seclusion is being used appropriately in terms of human rights and Convention rights?

  Dr Ladyman: As I said earlier, I believe that the guidance we give in Chapter 19 of the guidance is absolutely in line with Convention rights and it includes very thorough guidance in terms of seclusion and medication. The guidance, in my view, is comprehensive; it is easy to understand; it should not be being misused. So, I am very confident that we have the right framework that complies with the Convention. Do people sometimes fail to follow the guidance? Yes, of course. Do they do that maliciously? Very seldom, in my view. I think they probably do it in crisis, as a result of poor training and as a result of difficult situations where they have to react quickly and they make poor errors of judgment. In terms of documenting what goes on, I think the process of requiring such events to be documented and audited is absolutely the right way to go about it. So, do I think that there is a wholesale failure to comply with the Convention? No, I do not.

  Q206  Lord Judd: Perhaps not wholesale, your word, but is there a failure that is worrying?

  Dr Ladyman: The smallest failure would worry me because it is something that I absolutely believe we have to comply with. The whole reason why we are transferring, for example, prison health to the National Health Service is because we not only want to meet people's Convention rights but we want to exceed them. We want to mainstream services across the prison environment. That is something this Government are absolutely committed to. So, the smallest breach of anybody's rights is something that concerns me.

  Q207  Lord Judd: Would you agree that one of the issues you are up against in your specialist responsibilities is the whole institution culture within which you are operating?

  Dr Ladyman: Yes.

  Q208  Lord Judd: And that what needs to be spelt out far more clearly in terms of the objectives of the whole operation is the preservation of human rights?

  Dr Ladyman: I absolutely agree with that, but I do also believe that we are doing a great deal of work to try and get that message over to the people who work in both environments, both the prison environment and mental health environment. We are working very hard to get this message over to make sure that people understand what somebody's human rights are and what we require of them in ensuring that those human rights are met with. Can we do more? Of course we can, we can always do more. Are we working hard to try and make sure that the people understand what their responsibilities are? Yes, we are.

  Q209  Lord Judd: Do you think sometimes your people who are operating in this situation have to face the very real psychological tensions of being regarded as "softies" in the operation?

  Dr Ladyman: In the prison environment, I suppose there is always a temptation to feel that that may be the way they are being looked at. I do not think that is a general trend. I have to say that on both sides of this equation, both the prison health side and the mental health side, the people I have met and the practitioners I have discussed this with have never given me that feeling. I have to say that we are always guilty of stereotyping and the noble Lord mentioned that in term of minority ethnic communities. I think we are occasionally guilty of stereotyping when we talk about people who work in the Prison Service and also in the mental health service. They are not the Mr Mackay type figures of Porridge. They by and large are people who very much understand the responsibilities of their jobs and the need to respect people's human rights, but they work under very difficult circumstances. They work under circumstances that you or I would probably not be prepared to work under.

  Q210  Lord Judd: I think that is a very fair answer, but would you agree that just as there is need for training in human rights and the understanding of human rights and the importance of human rights with your people, so there is a great need for more understanding in the Prison Service as a whole about the needs of mental health?

  Dr Ladyman: Absolutely and in fact I am delighted to say now that as part of prison officer entry level training, there is a specific course on people's healthcare needs including mental health needs. We now have continuing training for all levels in the Prison Service including governor level, so it is not a matter of just getting your training during your basic training period and then you do not have any more training, you have on-the-job training going on. We have also commissioned a training package and I think it is the University of Bournemouth that is preparing a training package which is intended for people who are working on the wings in order that they will have the knowledge and experience of how to manage people's healthcare needs and mental health needs and then they can teach their colleagues of what is going on. So, we are doing a raft of things to try and make sure that people have the knowledge and training that they need, but I am the first to say that we can always do more.

  Q211  Lord Judd: I would like to spend a moment or two on medication. Some of the evidence that we have been given suggests that use of medication is excessive and that it is sometimes without medical authorisation as required by the Mental Health Act. How far do you think this is a real problem and again what about the Convention on human rights here?

  Dr Ladyman: I would be very interested to see that evidence because, from the feedback I am getting, it is not a widespread practice. We have, for example, the National Institute of Clinical Excellence guidelines when we have to administer tranquillisation other than for people's treatment and I expect NICE guidelines to be followed wherever they exist. So, if this is a widespread practice, I would be horrified, to be frank with you, and very surprised. I do not think it is a widespread practice. Does it happen occasionally? Yes and we would be surprised if it did not. Again, the process of having to document and audit any such acts is the way in which we ought to be picking that up.

  Q212  Lord Judd: You said that, if it happens on a small scale, it is a ground for concern. What would you do about it?

  Dr Ladyman: Every time medication has to be given in these circumstances, the management of the institution should be auditing exactly why and should be investigating and making sure that the people who actually took the decision to do it took an informed decision for the proper reasons. I think that management in those institutions ought to take disciplinary action if they find anybody has been abusing this on a systematic basis. Of course, when we transfer particularly mental health inspection to the Commission for Health Audit and Inspection from April, I think they will provide a mechanism for auditing the auditors to make sure that we are not missing a trick and that these things are not being hidden.

  Q213  Lord Campbell of Alloway: I take your point totally. What you are in effect saying—and correct me if I am wrong—is that you expect the guidelines to be followed and those guidelines are in Chapter 19 of the statute and those guidelines include medical treatment. What else can you do in practice as a department apart from training and perhaps urging people to observe them? What else can you do? Perhaps there is something, I do not know.

  Dr Ladyman: I think there is one thing that we have to do. We have to make sure that there is a body in place that can audit what is going on and that is why the Commission for Health Audit and Inspection has been set up. We also of course have to make sure that there is a route for people to be able to complain if they think their human rights are being breached.

  Q214  Lord Campbell of Alloway: But you do not want them to have statutory force; there is no need for that.

  Dr Ladyman: I do not believe there is a need for them to have statutory force. Of course, I will take cognisance of any advice that this Committee produces on that matter but, at this stage, I do not believe they need statutory force. I think that people have understood the system since the '83 Act and there is a little bit of me which thinks, "if it ain't broke, don't fix it", but of course I am waiting. If people have evidence that it is broken, then of course we will take that onto account.

  Q215  Lord Campbell of Alloway: You section people with severe mental disabilities, as I understand this—and correct me if I am wrong—if they are treatable but, if they are not treatable, you cannot section them; is that right?

  Dr Ladyman: I think I would probably have to write to you with the exact legal position but, broadly speaking, that is correct.

  Q216  Lord Campbell of Alloway: We heard evidence to that effect. I am putting it in very simple language—I know that much more beautiful language was used—and what happens is that the ones who cannot be sectioned because they are not treatable are sometimes not in as bad a mental state as the others, if you follow what I mean, and what happens is that very often one of these people who has been sectioned because they were treatable is then transferred from one prison to another prison to be treated but then they behave in such an aggressive and terrible fashion that they then decide that they not treatable and they are transferred back to the prison from which they came. I am not joking, this is the effect of the evidence that we have heard and I, and I think some others of us, were shocked about this when it was referred to by Anne Owers, a very distinguished person in this field, as "sale and return prisoners" as they were known in the Prison Service. Have you heard this?

  Dr Ladyman: I have heard the characterised pathway you are describing; I would be very interested to see some case studies where it actually has happened in quite that dramatic a way.

  Q217  Lord Campbell of Alloway: I am sure that, if you write to Anne Owers, she will give you chapter and verse because she gave the impression of knowing exactly what she was talking about and was a very good witness. What are we to do with this? This is very unsatisfactory position. If you do not know very much about what is going on here, what do you think should be done about it?

  Dr Ladyman: One of the reasons why we are reviewing the mental health legislation at the moment is precisely because we recognise that there are some flaws in it. So, we will try and address those legislative flaws in the new Bill when we finally put it before Parliament. So far as the treatment of people in the Prison Service is concerned, I think the Chief Inspector is certainly right that there are some people in prison with serious mental illness and of course, amongst the various things that we are trying to do is to try and stop them getting into prison in the first place. So, we have a range of measures in place now where people go to court and we try and assess whether they have mental illnesses, whether they would be better treated outside the Prison Service. We are providing a wider range of sentencing options to the courts and some discretions. The second thing we are trying to do is upgrade within the Prison Service the healthcare system across the board, which is why we are transferring it to the National Health Service. We have mental health in-reach teams, for example, to help people in the Prison Service. We have a wide range of initiatives to try and improve both the physical environment for people with mental health problems in Prison Service as well as the treatment options that are available to them and of course we are making sure that the staffing in the Prison Service and training is sufficient to recognise and deal with people with mental health problems. One of the suggestions that the Chief Inspector put forward which was debated fairly hotly over the Christmas period was the idea of creating some new institutions for people with mental health problems and I am not convinced myself that that is the way forward and I think she recognised this herself when she made her comments. In doing so, we would be in danger of recreating the old asylum structures. So, I think that is something that I need to be convinced about before we would go down that route.

  Q218  Lord Lester of Herne Hill: Minister, as you will know, there have been some very welcome changes made by the Government, first in establishing an independent Police Complaints Commission and then extending the Prison Ombudsman powers to investigate deaths in prison. In the light of that, do you not think that the absence of a system of independent inquiries into deaths in Mental Health Act detention is now starkly anomalous?

  Dr Ladyman: I do not believe it is starkly anomalous.

  Q219  Lord Lester of Herne Hill: So, it is just anomalous?

  Dr Ladyman: I believe it is different and I believe that there are mechanisms in place for investigating deaths in mental health institutions including the Mental Health Act Commission and including the normal process that would be gone through by a corner and the criminal justice system as well if somebody has died under suspicious circumstances. So, I believe that there are mechanisms and I remain to be convinced that we need further mechanisms to investigate such deaths, but again it is not something that we have a closed mind over.

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