Examination of Witness (Questions 220-221)
Dr Matt Muijen
7 DECEMBER 2006
Q220 Baroness Morgan of Huyton: I have
a final question on a very vulnerable group. We are aware that
there are disproportionate numbers of people in prison with mental
health problems and we are interested in what lessons you have
for us, what does and does not work here but in particular are
there any examples in other parts of the EU or anywhere else you
have seen of good practice in this area, because it is clearly
the poor relation?
Dr Muijen: Yes. I have consulted my colleague
Lars Moller who is responsible for the Health in Prison network
at WHO Europe, and we looked at the best practice website to identify
good examples of practice in prisons, and we came up with one,
which is in Holland. In essence it is a specialised mental hospital
for people in prisons, which is probably not the most imaginative
but it is the best we know of. The problems are the same everywhere—very
high levels of depression, very high levels of severe mental illness
all together with very poor treatment conditions. My most upsetting
visit in the last two and a half years was a visit to a prison
in a country I will not name but it was an EU member, where we
saw a few units for people with mental illness and these were
the worst cells—dark, mediaeval, where people were supposed
to stay for weeks and they had stayed for three years in some
circumstances. It is not just that that no positive care is taking
place in many countries but that you get a worse deal if you are
identified with mental illness, with what could only be described
as a Stalinist prison doctor showing a remarkable lack of care
for patients. It was a very frightening example of bad practice.
There are examples of good practice which are on the whole in
modern forensic units. To some extent it is obvious, but if one
looks at a more inclusive form of care, again, you do not need
to go beyond England. There are excellent liaison schemes between
prison and the community and there is at the moment quite a bit
of build-up of specialist support in prisons. It is no doubt not
enough but it is a start. Sadly, there are not a lot of additional
inspiring examples from elsewhere.
Q221 Baroness Gale: Could I just ask
you if there are good examples in other parts of the world?
Dr Muijen: Unfortunately I do not know many
details from elsewhere in the whole world. I do not even know
the whole of Europe, and, of course, prison care is not my special
area. The main concern in prisons is HIV and TB. Mental health
is marginalised. I think that leads to the same consequences as
being stigmatised. It is marginalised together with many other
disorders. I suspect that care is mostly rather ad hoc and if
one is lucky there will be special units with a few beds.
Chairman: Thank you very much for a very
useful session. We have already kept you here longer than we should
but if any of the things that we have said to you, or that you
perhaps have not been able to say to us because of shortness of
time, do come to you please give us the benefit of your thoughts
because I think it has been a very stimulating session, especially
looked at from your particular perspective, and has helped us
to see things in that structural context in a rather reassuring
way. We know a little bit more about how all that works now, and
obviously your experience and knowledge of what is going on in
the rest of your own patch has been very helpful to us. On behalf
of the Committee please let me thank you most sincerely for your
evidence today. If necessary we will be in contact with you but
I think you recognise that you are what we call a very busy person,
so we must not impose too much on your time and kind attention.
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