Joint Committee On Human Rights Minutes of Evidence

Examination of Witnesses (Questions 220 - 238)



  Q220  Lord Lester of Herne Hill: I am sure we are glad to hear that but given what I have just said about other mechanisms, are you reviewing the power of the MHAC or its successors to provide a statutory basis for a full independent inquiry because, on the face of it, it is very odd that there should be a full independent inquiry into these other contexts but not in this one. Are you looking at reviewing the powers of the Commission as a matter of priority?

  Dr Ladyman: At the moment, I would have to say it is something that we are not minded to do but we are open minded about it.

  Q221  Lord Lester of Herne Hill: Why are you not minded to do it?

  Dr Ladyman: Because, as I say, I think that there are mechanisms in place at the moment which adequately allow the investigation of deaths in mental health environments, but again the report of this Committee will be helpful in formulating our future views.

  Q222  Lord Lester of Herne Hill: Do you think it satisfies Article 2 of the European Human Rights Convention for the status quo to exist?

  Dr Ladyman: I do.

  Q223  Lord Lester of Herne Hill: You think it does?

  Dr Ladyman: I do.

  Q224  Chairman: Minister, we are aware that the National Health Service assumed responsibility for the prison healthcare system in April of last year. How would you say the prison healthcare system has changed since that date and what changes would you envisage in the future?

  Dr Ladyman: I think the partnership between the National Health Service and the Prison Service actually had some serious benefits even before April of last year. I do not know if the Committee is aware but we put in a traffic lights system for assessing the quality of health services in prisons where red is a healthcare service with serious deficiencies, amber gives cause for concern and green is considered to be adequate and, from 1999 to 2003, we went to a situation where there was a significant number of prison healthcare services at red to a situation in 2003 where there were none at red and the vast majority were at green. Only 24 remained at amber and 114 at green by 2003. So, a significant improvement already as a result of the partnership work. So, what would I expect now between 2003 and 2006 when we fully take over or PCTs take over full commissioning? I would expect to build on that foundation; I would expect to see a general improvement in healthcare services everywhere but, more importantly, I would expect to see what we call mainstreaming of services. So, to see services delivered in prison as they would be if people were not prisoners in the sense that, if you were not a prisoner, you would receive treatment for something in your home, then we should be able to deliver the same standard of treatment to you in prison in your cell on your wing which is the equivalent of your home whilst in prison. If it requires you to be hospitalised whilst you are not a prisoner, then it would require you to be hospitalised if you are an inmate. So, we would want to see the same strategies and the same quality of health service in prison and outside prison.

  Q225  Chairman: Would you say that the high rate of the imprisonment of mentally ill people indicates a failure of or a function of the failure of mental healthcare available in the community generally?

  Dr Ladyman: I would not take the view that it is a failure of healthcare in the community. I think it is inevitable that more prisoners will be people with mental health problems than in the general community. I agree with you that it is a horrifying level of people that have a mental health disorder in prison. There are five categories of health disorder and 90 per cent of people have at least one of those disorders. That is a horrifying level, I agree. I have to say that I think it gives us a huge opportunity that hitherto I do not think we have fully exploited and that is that, if we can help people whilst they are in the Prison Service system to overcome that mental illness, whether it is drug abuse and alcohol misuse or any of the other mental disorders, and support them whilst they are in prison, then we are going to make dramatic improvements to the offending rates when people leave prison. So, it is something that worries me and which shocked me when I first took over this role and discovered how high the levels were in prison but, no, I do not think it is a reflection on mental health treatment in the community.

  Q226  Chairman: In some of their evidence to us, Mind have suggested that people's general level of mental health tends to deteriorate while they are detained in prison; would you agree with that statement?

  Dr Ladyman: I think that is generally accepted but, equally, I think we have to ask ourselves what we mean by that. Prisons are not supposed to be fun places to go to. By definition, you are being punished. You either have the prospect of a trial or you have the memory of your trial, you have then a period of incarceration with your liberty curtailed, you have to deal with what your family and friends and what the community you have left may be thinking about you and what you did or what they perceived you did. It is a place that is bound to exacerbate any underlying mental health condition that you have had and to expose any that has not been spotted before you came into the prison environment. So, yes, I think it is generally accepted that mental health will deteriorate in prison, but I do not believe it is necessary for it to deteriorate to serious levels while you are in prison.

  Q227  Lord Judd: Surely you are quite right when you imply and more specifically say that prisons are not fun places to go to but, on the other hand, surely one of the principle objectives of prison is not only punishment but rehabilitation and, if there is a question of mental health deteriorating at all, this is working right against the whole objective of rehabilitation and is something to be taken extremely seriously.

  Dr Ladyman: Absolutely and we are taking it extremely seriously and that is why we are transferring prison health services to the National Health Service in order that we can take it even more seriously in the future. What I mean to say is that, when you go to prison, there is bound to be an element of depression about it. If it was not depressing you, it would not—

  Lord Judd: If I may say so, I thought you described that rather well.

  Q228  Chairman: The Chief Inspector of Prisons, Anne Owers, recently said there is a need for what she called a new generation of institutions which focused on treatment and interventions where mentally ill people can be detained rather than going to prison; do you agree with that?

  Dr Ladyman: As I said earlier, I would need a lot of convincing that it is necessary. Yes, 90 per cent of people have characteristics of one of the five mental disorders whilst they are in prison, but a much smaller proportion of them are seriously mentally ill. I think we have estimated that there are about 5,000 people in prison who are seriously mentally ill and the question I would have to ask is, what sort of level of mental illness is it that she is proposing we build new institutions for? If it is people with very serious mental illnesses that she is proposing that we build new institutions for, then are we not in danger of recreating the old asylums, which I expect everybody would immediately criticise us for, quite rightly, if we tried to go down that route. Given that we are in the middle of a process of mainstreaming prison health services, doing things we have never done before in this country to drive up the quality of prison health services and to take issues like mental health of prisoners far more seriously than we ever have in the past, I think that, before we go down the route she is proposing, we would be very well advised to see how well the route we are following at the moment works, bearing in mind that we do not even have the first primary care trusts taking over prison health services until this April. We are at a very early stage in a process which may address the problem and I think will address the problem that she has identified.

  Q229  Chairman: We also heard from the Chief Inspector that the average period between the diagnosis which could lead to sectioning under the Mental Health Act to allocation to a secure hospital is generally about three months and she said to us that those are three months in which a prisoner could deteriorate quite dramatically. Is there going to be a focus on trying to shorten that period?

  Dr Ladyman: Yes. I think we have to focus on that. I think we estimate that, at any one time, there are about 40 people waiting three months or more for a transfer and we need to make sure that the gap is as short as possible and that, for the period they are awaiting a transfer, the health services we are providing them within the prison environment where they are is as appropriate as possible.

  Q230  Mr Stinchcombe: Minister, I would like to take you to some more general healthcare issues outside of the mental health remit. Firstly, drug detoxification. Do you agree that drug addiction is one of the most significant healthcare problems facing the Prison Service?

  Dr Ladyman: Absolutely. We estimate that it is 40 to 50 per cent of male inmates have substance abuse problems and about 60 per cent of the women.

  Q231  Mr Stinchcombe: To what extent is patient maintenance treatment available to prisoners with addictive problems?

  Dr Ladyman: I would have to write to you with the percentage of people to whom it is available. In general terms, I would have to say that the non-clinical services we provide to people with substance abuse problems in prison are fairly generally available across the prison estate but the clinical services at this time are much more patchy.

  Q232  Mr Stinchcombe: What precise steps have you taken to improve detoxification programmes within prison?

  Dr Ladyman: We are generally looking at the extension of clinical services and the opportunity for different prescribing options to be made available according to the clinical judgment of people who are caring for prisoners and we are making detoxification facilities available much more widely across the prison estate, but I am the first to say that it is not widespread.

  Q233  Mr Stinchcombe: To what extent are you protecting those who have been detoxified in prison by providing them with Naltrexone to block the impact, for example, of heroin, whilst they are in prison and of course when they are released?

  Dr Ladyman: I think that there is an issue there. As I say, we do not think that the availability of clinical services is widespread enough in the Prison Service yet, so we need to extend that and I accept that entirely, and, from my experience of talking to professionals within the healthcare service, one of the things that we have yet to get right is the length between the detoxification programmes and the treatment programmes we have put on whilst people are in post and the support we provide for the aftercare after they are released. What governors typically tell me when I go to visit prison health centres is that, if somebody is in prison for a few months, then they can usually get them off drugs or help them with their substance abuse programme during that time but, quite often, they are immediately released back into the environment from which they came, often without a proper care plan and they quite often find themselves going back to sleep in the same flats and the same places where the people who got them into trouble in the first place are.

  Q234  Mr Stinchcombe: Could you drop a line to the Committee with the figures as to the percentage of prisoners who are specifically offered Naltrexone treatment.

  Dr Ladyman: Yes.

  Q235  Mr Stinchcombe: Can I turn quickly to communicable diseases. I think you will agree that a percentage of inmates suffer both HIV and Hepatitis B and C significantly higher than the outside community and presumably that is because those inmates had the disease transmitted to them in the normal way either through sharing needles or through having unprotected sex.

  Dr Ladyman: Yes.

  Q236  Mr Stinchcombe: I take it that the Department of Health is promoting needle exchanges and sterilisation of needles and also condoms in the wider community.

  Dr Ladyman: Yes.

  Q237  Mr Stinchcombe: Will it also promote those programmes inside prison?

  Dr Ladyman: Certainly, there was an attempt to introduce disinfecting tablets which was withdrawn and is now being reintroduced under a pilot programme which we carried out some analysis on. So, we think disinfecting tablets for those people who are using equipment inside prisons is an important way forward. Our experience so far of the needle sharing schemes in prison has not been particularly successful but I am open minded about anything. Condoms in most places are available on a confidential basis in prisons where we think it is necessary.

  Q238  Lord Lester of Herne Hill: Minister, we would be grateful if you would provide us with evidence rather than assertion as to why Anne Owers is wrong because I think that is what you are saying when she says that there is a real need for a new generation of institutions with focus on treatment and intervention so as to get people out of prison who should not be there because of their mental disorder. Can your department provide evidence—I understand the assertion—because we have to form a judgment in the end as to whether we accept her evidence or not? So, if you have evidence to the contrary— I have evidence that supports her from my own experience and you clearly must have visited prisons yourself, but can you hereafter provide us with chapter and verse, please.

  Dr Ladyman: I will certainly write to you and give you a considered view on it. I do not think that the Chief Inspector was actually putting this forward as a proposal for an immediate start. I think she was flagging it as an option that we ought to be looking at as well. I am happy to give you a response on it.

  Chairman: Minister, thank you very much for appearing before us today. It has been very helpful to us as we continue our examination of the very serious issues that arise from deaths in all forms of custody. Thank you very much.

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