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Lord Hunt of Kings Heath: My Lords, as regards the noble and learned Lord's second point, we certainly wish to ensure that whatever proposals we bring before your Lordships' House will be complicit with the European Convention on Human Rights. A very important safeguard throughout these processes will be the role of the mental health tribunal and its ability to review cases and, for the person subject to such an order, the help of advocacy in relation to the issue to be decided by the tribunal.

As to the noble and learned Lord's first point, the new legislation that we propose will provide for the Home Secretary to direct a prisoner to undergo a specialist assessment for mental disorder, in addition to powers to transfer to hospital for treatment. Such a specialist assessment will take place in an appropriate environment, which could be in a hospital or in a designated section of a prison. In particular, this will allow for specialist assessment of prisoners who are high risk before decisions on possible transfer to a specialist mental health unit are considered.

When a transferred prisoner reaches the date on which he or she would have been released from prison, authorisation for continued care and treatment would be subject to the clinical supervisor submitting an application for approval by the mental health tribunal in civil proceedings, as outlined in the White Paper. Where the patient remains subject to compulsory powers on expiry of his or her restriction direction because of the risk of harm they pose to others, the tribunal ordering continuing care and treatment will be able to require that decisions on discharge, leave and transfer should be referred to it for prior approval.

Lord Skelmersdale: My Lords, things have moved on an awful long way in the 15 years since I first became responsible for mental health within the noble Lord's department, both in the thinking about mental health issues and in the treatment and care of mentally ill patients. But, as I understand it--following on slightly from the noble and learned Lord's point--there has always been a problem with psychiatrists in the prison service.

The prison medical service has over the years had varying numbers of psychiatrists. The most important thing for a prisoner is to be identified as mentally ill or not. The only person who can do this is the prison

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psychiatrist. Are prison psychiatrists currently up to strength, or is this something that some of the extra #100 million-odd mentioned in the Statement will be spent on?

The Minister mentioned in the Statement the secure beds scheme and prided himself on an extra 500 beds. Does that mean 500 beds from now on, or are the beds already there? If so, from when, and do they exist in every health region?

Lord Hunt of Kings Heath: My Lords, the noble Lord raises an important issue; namely, the overall quality of prison health services, particularly prison mental health services. There is no doubt that we need to see improvements in the overall quality of the service. In March 1999, the report on the future organisation of prison healthcare set out a number of recommendations for improving services overall, including an examination of both the quality of the service and the number of staff who should be employed, including consultant psychiatrists.

We accepted the report's recommendations. We have established a joint task force and a policy unit, which is working hard at visiting every prison and each healthcare centre, identifying those prisons where major investment needs to be made in terms of either capital or staffing. The important development is the endeavour to have the health service link with a local prison, so that there is a stronger interrelationship between local services and prison services. It means that the prison healthcare service is less isolated. It also enables people to transfer, so that there can be rotations of staff--people can perhaps work part-time in the health service and part-time in the Prison Service or they can go in for tours of duty. That will be the way in which we shall tackle some of the problems that the noble Lord rightly identified.

The noble Lord is right also to raise issues regarding the number of secure and medium-secure beds. The 500 beds are additional beds that we want to see brought in. I do not have the details of the timing and when that plan will come to fruition; clearly, it remains an important part of the whole process of improving mental health facilities that such facilities should be available. One of the problems in relation to prison healthcare services is, for instance, the backlog of prisoners who sometimes need to be transferred to other facilities. However, I am confident that we shall be able to make progress on that. It will be important, as was suggested, that facilities are placed in different parts of the country.

Lord Goodhart: My Lords, I should like to probe further into the second point raised by the noble and learned Lord, Lord Ackner; namely, the position of those who are detained or threatened with detention because they are alleged to present a risk of harm to the public because of a severe personality disorder.

As I understand it, the term "severe personality disorder" is used to describe people who are guilty, or thought likely to be guilty, of anti-social behaviour on a significant scale but who do not suffer from any identifiable mental illness. What will the position be if

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such people have no convictions? What standard of proof will be required to authorise their detention? The Statement talks about a "high risk of harm". We need to know how high is "high". Does it mean the virtual certainty that they will commit acts of violence in the future--in other words, proof beyond reasonable doubt? If the standard of proof is lower than that, how can their detention be justified? Can we really detain someone because we think it more likely than not that in future that person will commit some act of violence, or perhaps even that there is a significant risk falling short of probability? Those are important aspects and I await the Minister's response.

Lord Hunt of Kings Heath: My Lords, the noble Lord is right to identify this as an important issue. I am sure that when we debate the Bill in this House it will be a subject for the closest possibly scrutiny. I accept that the balance between the risk to the public and ensuring that people's individual rights are upheld becomes a crucial issue.

The consultation paper that led up to the White Paper and the proposal for legislation outlined the need for a systematic approach to the determination of whether an individual has a severe personality disorder and the level of risk that is posed to others. It said that any treatment needs would be assessed, leading to a plan of care and management to take account of public safety and the full range of interventions required.

The concept is that a screening assessment would take place in the Prison Service for those detained in prison and in the NHS for those detained under the mental health legislation or for those living in the community. The purpose of the screening assessment would be to establish whether there is sufficient evidence of someone having a severe personality disorder to justify a longer term intensive assessment and to establish whether the individual is sufficiently robust to undergo a full assessment. As part of the screening assessment, an individual's history would be considered and there would be an interview with clinical staff to assess suitability and to screen out more immediate mental health needs or other issues around treatment. The screening assessment would take place alongside the full diagnostic and assessment screening as to whether someone indeed had severe personality disorder and was dangerous.

I refer the noble Lord to the pilot work that is being undertaken in the NHS and in Her Majesty's Prison Whitemoor. These very ideas are currently being tested. At the end of that process we shall have a much clearer idea of where the balance is to be drawn. I accept that it is important to get that balance right. It is important that we also have the necessary safeguards--such as a mental health tribunal--to ensure that cases are subject to the appropriate review by people who are expert in these matters.

Baroness Fookes: My Lords, as a former member of the All-Party Mental Health Group, I warmly welcome the intentions of the Government in this matter. For too long, the mental health service has been something of a Cinderella service.

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However, will the Minister expand on a problem of which I had some experience as a constituency MP? I refer to the person who is allowed into the community but needs to take medication if his case is not to get much worse and who fails to do so; all kinds of problems and nightmarish scenarios can then occur. What in practice will be the position under the new legislation? Will that person have to report to a doctor's surgery? Will a mental health worker have to call at his house? How will that situation be dealt with in practice, bearing in mind that he may have to take medication three times a day?

Lord Hunt of Kings Heath: My Lords, there are two issues here. One is the question of monitoring and reviewing the progress of someone who is subject to an order. The important point to make is that alongside the order is a care/treatment plan--the two will go together. It will be up to the responsible authorities to ensure that, when an order is made, a care/treatment plan is also put into practice. That will involve the various mechanisms in place to develop appropriate mental health services in the community, including assertive outreach teams. That allows for 24-hour contact seven days a week with vulnerable people.

At the end of that process, there is no question of medication being applied compulsorily within the community. But if the process breaks down and it is clear that an individual is not following the treatment programme and the order, it is possible to ensure that the person comes back into an institution where such medication can be given.

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