Clause 62 - Mental health treatment requirement

Legal Aid, Sentencing and Punishment of Offenders bill – in a Public Bill Committee at 4:45 pm on 15 September 2011.

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Question proposed, That the clause stand part of the Bill.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

I am afraid that we are not going to reach such speedy agreement on clause 62, about which we have considerable concern.

There will be agreement that the mental problems suffered by many people in the criminal justice system are extremely worrying. They range from depression to severe psychosis. I do not think that the picture about what is going on is entirely clear, but all the numbers are going in one direction. I think that 10% of men and 30% of women have a previous psychiatric admission when they are sentenced. Michael Spurr, who was the head of the National Offender Management Service

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

I thought he had moved on, but I am happy to be corrected by the Minister on that point.

Michael Spurr believes that 10% of people in the criminal justice system suffer from serious mental health problems. The Royal College of Psychiatrists believes that 90% of people have a problem, and 70% of people have two problems. The Opposition agree that prison is not suitable for such people. It is a matter of concern that last year, only 1,200 people were moved from the prison estate to an NHS secure hospital. That might be connected with the fact that while the cost of a prison place is just over £100 a day, the cost of a secure hospital place is about £480 a day. That is why we think that the £5 million that the Ministry of Justice and the Department of Health have put into diversion is helpful. However, before the Minister tells us in too glowing terms how marvellous that is, I point out that in reality it would pay only for between 40 and 60 professionals around the country. They will be offering a signposting service, not the extra treatment needed where there is a massive shortage of resources. The Centre for Mental Health estimates that sorting out the problem would cost about £50 million, although I accept that community treatment with drugs is a cheaper option.

We are concerned about the Government’s view that a decision to send somebody for mental health treatment can be made without the advice of a medical professional. The Minister will say that this is another instance of where that is not what the legislation means, but that is how we have interpreted it.

Photo of Crispin Blunt Crispin Blunt Parliamentary Under-Secretary (Ministry of Justice) (Prisons and Probation)

The hon. Lady used the term “medical professional”, but the clause refers to a senior clinician.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

I am slightly puzzled by what the hon. Gentleman has just said.

Photo of Crispin Blunt Crispin Blunt Parliamentary Under-Secretary (Ministry of Justice) (Prisons and Probation)

If the hon. Lady will allow me, I will make the case for the clause to stand part of the Bill, and she can come back if she wishes to pick up on any points. She may have misunderstood the intention behind the clause.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

Mr Hollobone, is it appropriate for the Minister to speak first when I am objecting?

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

Order. The hon. Lady is welcome to come back later in the debate if she so wishes.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

In a spirit of helpfulness, I will listen to the Minister, but I am not optimistic.

Photo of Crispin Blunt Crispin Blunt Parliamentary Under-Secretary (Ministry of Justice) (Prisons and Probation)

Given the hon. Lady’s remarks about medical professionals, my comments may enable her to support the clause. It aims to simplify the procedural requirements necessary for a court to impose a medical health requirement treatment as part of a community order or suspended sentence order, and it removes the specification for a senior clinician—a section 12 medical clinician, as specified under the Mental Health Act 1983 —to carry out the initial mental health assessment. The clause removes the reliance on senior clinicians, who tend to operate in secure mental health services and in general do not deal with lower severity cases where a community-based approach through a mental health treatment requirement would be more appropriate. It means that a broader range of mental health specialists, such as doctors practising as psychiatrists, and psychiatric nurses and psychologists, can carry out the initial health assessment, and it will help to ensure that assessments are carried out more promptly and reduce court delay. If necessary, complicated and particularly serious cases can be referred to senior clinicians.

The clause does not affect existing requirements, which will maintain the safeguards necessary for administering a treatment requirement. Before making the requirement, the court must continue to be satisfied that an appropriate assessment of need has been carried out, that arrangements are in place for treatment to be delivered, and that the offender has expressed their willingness to undertake and comply with treatment. The legislation addresses a serious and appropriate issue, and I hope that the hon. Lady will be reassured.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

I am not reassured. I knew there was a practical problem; I was going to address it and will tell Government Members why. As I understand it, the Mental Health Act 1983 extended the range of professionals whose approval was necessary to certify treatment. In the Mental Health Act 2007, the definition was broadened to include the following: a registered medical practitioner, a chartered psychologist, a first-level nurse whose field of practice is mental health or learning disability, a registered occupational therapist, and a registered social worker.

The Minister seems to suggest that it is difficult to get reports from that long list of professionals. Opposition Members, however, feel that the clause is too risky and that it is inappropriate. Evidence from the Royal College of Psychiatrists and the charity, Rethink, shows that  people are currently paid only £60 for writing such reports, before court proceedings. For that reason, there is huge difficulty in getting those people to prioritise them in their work load, which is why the pre-sentence reports take time to write and why there are delays.

We have had evidence from somebody—since the Minister disrupted me, I cannot find my notes. However, evidence shows that when the right medical report is not received at the right time, people may end up having more court hearings than they would have had otherwise. We would like the Minister to understand the matter in a slightly different way, because we think that putting medical practitioners to one side carries two risks. The first is that people who should have mental health treatment do not get it. The second, which is equally problematic, is that people who do not need it, get it. I put it to the Minister that such a situation would be rather Kafkaesque.

Furthermore, evidence given to the Justice Committee in 2008 found that defending barristers frequently recommend their clients to refuse to go along with mental health treatment requirements if the requirement, which is part of the community order, is longer than an alternative custody sentence that might be given. That is seriously problematic, because for completely inappropriate reasons, people are not getting the treatment that they need. People suffering from mental health issues are not in the best position to judge their own mental health, and those who are involved in the criminal justice system are already people who, because of mental health problems, may sometimes—not always—be extremely difficult to manage. The Minister is trying to rely solely, as we read the proposals, on the individual’s consent.

Another point made by the Royal College of Psychiatrists was that where a person refuses treatment but still requires it under a mental health treatment order, they might not fulfil the criteria for sectioning. That is why the college would like to see a section 12 approved person involved in the process.

I am sorry to say that the proposals look like a very inappropriate public spending statement, which is not at all in line with the Bradley report of 2009, which said:

“The first step to the effective management of offenders is the existence of good early identification and assessment of problems, which can inform how and where they are most appropriately treated.”

If we do not have the involvement of people who are medically qualified, that simply will not happen. Probation officers are not trained in mental health and it is quite wrong to put responsibility for making judgments on to them, just as it is unfair to the offenders.

I hope that the Minister read the Bradley report before he proposed the measure. Let me remind him of what Bradley said. He said that the pre-sentence report needed to address four things: culpability, or whether the mental health problem explains the crime; the risk of repeat; the feasibility of the community order versus custody; and supervision, should psychiatric treatment be involved. He also wanted the sentencer to consider whether going to prison would make the person’s mental health condition better or worse.

Instead of sorting out the problem, managing the system properly—the system does not work as well as it should at the moment—or putting in resources, the  Government are simply abandoning the idea that medical professionals should be involved, and we cannot go along with that.

Photo of Crispin Blunt Crispin Blunt Parliamentary Under-Secretary (Ministry of Justice) (Prisons and Probation) 5:00, 15 September 2011

With leave, Mr Hollobone, I will reply. The hon. Lady has very properly raised her concerns, but there is a serious danger that if the Committee accepts her amendment, it would have the unintended consequence of preventing mental health treatment requirements from being made and getting people in a timely fashion into mental health treatment. The current requirement is for a full psychiatric report to be carried out by a senior clinician—a section 12 doctor as per the Mental Health Act 1983. The limitations that we are trying to remove act as a barrier to getting more eligible offenders on to a mental health treatment requirement. Those doctors tend to be found in secure mental health services and do not generally deal with mental disorders at a minimum or lower level of severity, where a community base would be more appropriate.

The hon. Lady will share with me and with Lord Bradley the objective of getting people into mental health treatment when that is more appropriate, rather than into justice treatment. The practical problem with the limitations under the law as it now stands is that the current process for receiving an assessment can take several weeks, even up to two months, which causes delays in court time as well as for offenders who require mental health treatment.

The hon. Lady says, “Get more senior clinicians in place to make these assessments.” It would be great if we could turn round and manage to deliver that, but she will understand that in the current resource environment, that is not a practical outcome. We are faced with the proper choice to be made. It would be a perfect situation if there were enough senior clinicians to carry out all the assessments, but there would be an issue about whether they were being diverted from people for whom they were more appropriate. However, we are not in that position. We want people to have timely access to mental health treatment requirements.

Photo of Tom Brake Tom Brake Liberal Democrat, Carshalton and Wallington

While the Minister is on the subject of mental health treatments, may I mention another point, on which I am sure he is also pushing? People in prison are facing significant problems in accessing mental health treatment, because their primary care trusts are not dealing with them quickly enough.

Photo of Crispin Blunt Crispin Blunt Parliamentary Under-Secretary (Ministry of Justice) (Prisons and Probation)

The whole area of the mental health requirements of offenders, as brought up by Lord Bradley’s report, which we fully endorse and support, is one where we must make much better progress. The unintended consequence of the hon. Lady’s amendments would be to prevent us from improving the situation and getting people into treatment in a more timely fashion.

Photo of Helen Goodman Helen Goodman Shadow Minister (Justice)

The Minister’s remarks are disappointing and inappropriate, and his arithmetic is not even right. We are all agreed that psychiatric reports written by the four classes of medical professional are not currently arriving in a timely way. I urge the Minister to look again at the Bradley report, which made two cost-benefit analyses. One addressed the court process and one looked at effective sentencing to the community.  On the court process, Bradley found that spending money properly on speeding up the arrival of reports and managing the situation, would bring a net benefit to the taxpayer of £3 million, because fewer people would be sent to remand. On sentencing, the report took the view that people getting the mental health treatment requirement orders that they wanted, rather than going to prison, would benefit some 2,000 people and produce significant savings, estimated at £40 million.

Ministers have seen a problem—I am not running away from it—and have put it on the “too difficult” list. Rather than having a proper management response, they want to change the law. Opposition Members are extremely concerned, as I said at the outset, that the wrong people will get treatment, that the people who need treatment will not get it and that there is potential for serious infringement of people’s civil liberties. I am sorry, but we cannot support the clause.

Question put, That the clause stand part of the Bill.

The Committee divided: Ayes 11, Noes 6.

Division number 37 Decision Time — Clause 62 - Mental health treatment requirement

Aye: 11 MPs

No: 6 MPs

Aye: A-Z by last name

No: A-Z by last name

Question accordingly agreed to.

Clause 62 ordered to stand part of the Bill.