rose to call attention to the rate of suicides in prison, and the effect of overcrowding on vulnerable inmates; and to move for Papers.
My Lords, this debate is taking place at a time when another important event is taking place not far from your Lordships' House. I refer to the memorial service for Lady Blatch. Our thoughts and prayers are with her family.
Our criminal justice system is in a mess. How else can we explain the fact that the present prison population is the highest ever, at 77,622? Prisoners are being held in police cells because there is no room in local gaols, despite previous assurances from the Home Secretary that this would not happen. The prison system is now only 653 cells short of capacity in the 139 gaols in England and Wales.
We can of course consider building more prisons or providing more prison places, but that simply means that we will fill them more quickly. It does not answer the question of how the end product of our criminal justice system has produced a prison population that is so high. We are now obliged to look at other alternatives; for example, expanding the home detention curfew scheme, the executive release of offenders more quickly or release with an electronic tag. Any alternative to prison is welcome.
The problem of overcrowding has been getting worse rather than better. At the root of the problem is the fact that more people are being convicted and a higher proportion sent to prison. Sentence lengths are also increasing. Ministers' pronouncements on being "tough on crime" have not helped. There must be a clear message that we should be aiming to send fewer people to prison. We need a determined effort on the part of politicians to secure a decisive shift in the public perception of crime and punishment.
It is not revolutionary or controversial to say that courts should send to prison only those whose offending makes any other alternative unacceptable and that those who are sent to prison should not stay there any longer than is strictly necessary.
Let us look at the women's prison population. This stood at 4,559 on
So what are the consequences? The Parliamentary Joint Committee on Human Rights published a report at the end of 2004 on deaths in custody. It raised particular concerns about women, highlighting that, while women represent just 6 per cent of the prison population, 15 per cent of self-inflicted deaths and over half of prisoners resuscitated following serious self-harm in 2003 were women. The committee's recommendations included feedback to judges and magistrates on sentencing decisions, including self-harm and suicide, and a cross-departmental expert task force on deaths in custody.
I have often spoken about children in our penal institutions. The Howard League for Penal Reform, the Prison Reform Trust, Inquest and NACRO—I declare my interest as president of that organisation—have produced detailed briefings and I am grateful to them. I remain extremely concerned about the record number of people being sent to prison and the shockingly high numbers of those who take their own lives once there. Since
Another area of serious concern is the self-inflicted deaths of immigrant detainees. The number of self-inflicted deaths in immigration detention has significantly increased—seven immigrant detainees took their own lives between January 2003 and September 2005, yet there were only four such deaths between 1989 and 2003. The most recent death occurred on
So what should we do? First, we should focus on making necessary changes to the legal framework for detaining asylum seekers and migrants under immigration Act powers, to ensure that detention powers are limited by accessible and meaningful legal safeguards. Secondly, we should improve the investigative process if a death occurs, to ensure that wider lessons for policy and practice are identified and implemented, particularly in the absence of friends or family of the deceased in the UK to apply pressure.
The number of self-inflicted deaths in prisons in England and Wales last year totalled 94—the highest recorded number for a year. The number has risen from 65 in 1997. Expressed as a rate per 100,000 prisoners, the rate rose from 111 per 100,000 prisoners in 1997 to 127 in 2004—a wholly unacceptable figure. We all know that the Prison Service has an unenviable task in attempting to tackle this problem. It is accommodating a population of people who are significantly more likely to attempt suicide then the general population. Around 20 per cent of men and 40 per cent of women entering custody have previously attempted suicide. Over the years the Prison Service, led by its Safer Custody Group, has adopted a wide range of measures designed to identify potentially suicidal prisoners and to take the necessary steps to provide supervision and support for them. Yet the number of prison suicides has continued to rise. Why are we failing?
What more needs to be done to check and reverse that distressing trend? First, particular attention needs to be given and support provided to prisoners who have recently been received into prisons. More than half of suicides last year—57 per cent—were by remand prisoners, and almost one-third of suicides occur within the first week of a prisoner arriving in custody. Is extensive use of remanding in custody necessary? All establishments that receive prisoners from the courts should have first night in custody schemes and follow-up arrangements to support prisoners during that particularly vulnerable time.
Secondly, research on prisoners who have made unsuccessful suicide attempts has found that most suffer mental health problems that contribute to their attempts. Many of them—and this is particularly true of female and young prisoners—describe memories of physical and sexual abuse as a key factor in producing the mental state that leads them to attempt suicide. Nearly two-thirds of those who commit suicide in prison have a history of drug abuse and nearly one-third have a history of alcohol misuse. It is crucial that high quality services should be available for prisoners with mental health problems, addiction problems, and a need for counselling and support to cope with past experiences and abuse.
Thirdly, high suicide rates are associated with low levels of purposeful activity in prisons. Research into prisoners who have unsuccessfully attempted suicide has found that those prisoners emphasise the importance of greater access to work and activities both in and out of their cells. That provides a distraction from distressing thoughts and memories and gives them a greater opportunity to get informal support from other prisoners.
Fourthly, everything possible must be done to design or modify cells in ways that reduce opportunities for suicide by eliminating ligature points which prisoners can use to hang themselves. Between 1998 and 2004, the overwhelming majority—around 92 per cent—of prison suicides occurred by hanging. The most common ligature points were windows, which were used in 59 per cent of cases, with the second most common being the bed, used as a ligature point in 17 per cent of cases.
Fifthly, prisoners serving life sentences are over-represented in the suicide figures. Between 1998 and 2004, 21 per cent of suicides involved life sentence prisoners, who constituted 8 per cent of the prison population. Prisoners facing a long sentence are likely to face particular problems of depression, but when that sentence is not only long but also indeterminate their uncertainty over when, if ever, they will be released can only add to prisoners' sense of anguish. That is yet another powerful reason for reviewing the necessity of the mandatory life sentence for murder, so that courts can use determinate sentences in cases where the circumstances of the case make this the proper option.
The sixth and crucial point is that the Government must make determined efforts to reduce the prison population. There is a clear link between overcrowding and the number of suicides. A recent research study found that 10 of the 20 establishments with the highest incidence of self-inflicted deaths were also in the top 20 for turnover of population.
Overcrowding damages the Prison Service's attempts to reduce suicides in several ways. First, it makes it more likely that signs of depression and suicidal intent will be overlooked when staff are struggling to cope with an excessive number of prisoners. Secondly, it makes it harder to provide a full regime for prisoners and makes it more likely that prisoners will be held in their cells in idleness for long periods. That can worsen depression, reduce prisoners' opportunities to get support from staff or other prisoners and help to tip the balance towards suicide. Thirdly, overcrowding makes it more likely that staff will miss signs of bullying and intimidation of weaker and more vulnerable prisoners, which is an important element in some suicides. Fourthly, it increases the pressure on prisons to move prisoners to prisons far away from their families and friends, making visits and family contact harder, which can increase the isolation and depression of potentially suicidal prisoners.
If we are to give the Prison Service a real opportunity to combat the rising toll of prison suicides, we must reduce the excessive use of imprisonment. It is particularly unfortunate that the Home Secretary has chosen to abandon his predecessor's commitment to the targets set out in the Carter review to reduce the projected rate of increase in the prison population from 93,000 to 80,000 and to require sentencing guidelines to take into account the capacity of the prison system. It is not too late for the Home Office to think again about these measures. By reducing overcrowding in the prison system, they would not only help the Prison Service to rehabilitate prisoners more effectively but would also save lives.
I beg the Minister to look at the proposals made by the joint Women in Prison/Fawcett Society's recommendations. They make sense, and I look forward to the Minister's written response on these matters. I also commend to the Minister Barry Goldson and Deborah Coles' publication In the Care of the State. It is about child deaths in penal custody. It would be helpful to receive the Minister's written comments on their recommendations also.
It is still possible to detect attitudes among politicians that the best thing to do with the criminal is to lock him up in our unpleasant institutions and throw away the keys. We forget that almost all but a handful of prisoners will be released from prisons one day. It is better to release people with a renewed measure of self-respect and a range of skills rather than allowing them a greater sense of grievance against society for the indignities, real or imagined, suffered during incarceration. The inmate is in the care of the state from the time the sentence is announced. We should hold the state responsible for what happens to him during that period. I beg to move for Papers.
I have to declare an interest. I am chair of the Prison Service Audit Committee and a non-executive member of the Prison Service change programme board.
One possible interpretation of the title of this debate is that there is a direct link between the rate of the suicides in prison and current levels of overcrowding. I am not sure that all the hard evidence necessarily points conclusively in that direction although one's natural inclination is to feel that it must be one possible factor among many. In Austria there has been a rise in the prison suicide rate during a period when the prison population has decreased, and so far this year in this country there has been a welcome reduction in the number of self-inflicted deaths at a time when overcrowding has increased. However, overcrowding in our prisons certainly is an issue and it has adverse effects on life in prison. Prison numbers are at record levels as the courts continue to exercise their judgment over who should be in custody and, more significantly, for how long.
Overcrowding and the associated increased weight of numbers produces its own pressures—leading to less time for inmates out of their cells, reduced access to work and other constructive activity and less effective operation of procedures relating to matters such as visits and reasonable access to showers and telephones. Prison staff are placed under greater pressure as a result of overcrowding and have less time to deal with issues or spot problems. More inmates also means that more staff resources have to be directed towards running areas such as reception for longer hours as the number of prisoners being moved in and out of a prison each day rises.
Overcrowding creates the possibility of disorder. The riot at Strangeways in 1990 and the wave of copycat riots in other establishments is one example. The loss and destruction of half of Wymott Prison in 1993 is another, as was the last major riot, in 2002, at Lincoln Prison. The loss of prison places as a result of another riot now and the resultant need to move existing prisoners elsewhere at short notice would cause considerable operational problems in a Prison Service already holding record numbers and at or near its full overcrowded capacity.
Accommodation being tight also increases the number of occasions on which prisoners have to be transferred to other establishments, some considerable distance from their homes and families and to which they do not wish to go, in order to maximise the use of the available accommodation. That is because, for reasons related to ability to contain pressures where they can be most effectively managed from both a safety and security point of view, overcrowding population pressures are concentrated mainly in the local prison estate rather than across the prison estate as a whole. Where such moves of prisoners have to take place it is less likely that staff will know prisoners or will have time to get to know them, which potentially reduces the flow of intelligence to prison staff. Such moves also increase the likelihood of intergang and group rivalries since prisoners in one area do not always appreciate an influx of prisoners from another area of the country. Feelings of tribalism can at times be quite strong and destructive of harmony. In local prisons high numbers of prisoners are locked up for about 22 hours a day with only limited time out to collect meals and have access to exercise.
This year it is possible on current trends that the number of self-inflicted deaths will be down on the last three calendar years and close to the target reduction figure. However, November and December, with the run-up to Christmas, are normally very difficult months. The three-yearly annual average figure is some 10 per cent over the target figure.
One question must be how suicide rates here compare with other countries. Unfortunately, it is difficult to draw comparisons of prisoner or offender suicide rates between different countries since there are differing definitions of what is regarded as a suicide and methods by which the rates in relation to the prison population as a whole are calculated. However, it is clear that suicide rates are higher in prison than in either the general population or the general male population. Studies also indicate that it is during the first day, week and month in custody that suicides are most likely, and that for this reason remand prisoners are among the most vulnerable.
Few studies have considered suicide rates among offenders under community supervision, but the work that has been done suggests that the rates for male prisoners are not higher than rates among male offenders outside prison. In England and Wales the suicide rates in the two groups were found to be similar.
A recent finding from England and Wales showed that the number of suicides by convicted prisoners in the year following release from prison was more than double the number in prison. Between April 1996 and March 2000, 354 convicted prisoners died by suicide in the year following release from prison—23 per cent of whom died in the first month after release and 12 per cent in the first week. This compares with a total of 167 convicted prisoners who killed themselves in prison during this period.
In England and Wales trends in prison suicide rates have paralleled reported trends in community rates. There has been an increase in the consumption of drugs associated with suicide risk, especially cocaine and crack in England and Wales. A high percentage of prisoners have been on drugs immediately prior to being convicted. Significant numbers suffer from mental illness and mental disorder. The prison population is mainly young males from lower socio-economic groups where the incidence of suicides in the population as a whole is highest. The prison population is not a cross-section of society but comes heavily from those groups most prone to self-inflicted deaths.
Any self-inflicted death in prison is a matter of real concern and regret. Those remanded or convicted are placed in the care of the Prison Service, and any self-inflicted death inevitably raises questions about the effectiveness of the care that was provided. However, some who are determined to take their own lives give little or no indication of that risk. Dr Shipman would appear to come into that category. The reports from the ombudsman who investigates self-inflicted deaths in prison recognise that in many cases the outcome could not realistically have been prevented.
Even with prisoners who do give signs that self-inflicted death is a serious possibility, it is far from easy to prevent that outcome over an extended period of time where there is an apparent determination to pursue that course of action. While attention will naturally be concentrated on suicide attempts that succeed, as I understand it no estimates are available to show what must be the very considerable number of suicides that have been prevented or thwarted by the actions and diligence of the Prison Service and its staff—actions for which they do not always get the recognition they deserve as too many people whose condition is a serious medical one end up in prison because there appears to be no appropriate place to send them. I refer to people who hospitals do not want because of their behaviour and attitude that makes them difficult patients; people whose mental problems may not previously have been fully diagnosed because they have been masked by the drugs they have been taking, but which come to light in prison as the drug taking stops; people who I understand claim they are "hearing voices" telling them to do things, including taking the most drastic step of all, which puts them at the top end so far as risk and seriousness of their mental state are concerned.
Overcrowding in prisons certainly creates operational problems but it is not the key issue so far as the incidence of prison suicides is concerned. The key issue here is the need to deal more effectively and appropriately with the serious mental and psychological problems of so many of those who seem to end up in prison as there is nowhere else to send them and for whom there has too often been no means of seeking to address their problems before the criminal offences resulting in imprisonment are committed.
My Lords, I want to express, on behalf of all those with a concern for these issues, my thanks to the noble Lord, Lord Dholakia, for initiating the debate. We are talking about an extremely serious matter. I speak in the debate principally as the bishop to Her Majesty's prisons in England and Wales, although the examples into which I shall take the House occur in my own diocese in Worcestershire.
We are dealing with a complex issue, and it is extremely important that the noble Lord, Lord Rosser, indicated that statistics on it simply often serve to heighten its complexity. The complexities are also highlighted by many of the suggestions and remedies put before us by the noble Lord, Lord Dholakia. For example, it is right that we need to attend to the construction and design of cells that do not have ligature points that facilitate hanging, but that in itself must not be done at the cost of putting highly vulnerable people in a situation in which they do not have access to ventilation. It is extremely difficult to be clear about the issues. But—if I may be blunt—we live in a society that professes not to find capital punishment acceptable. We therefore have to take with great seriousness our complicity in a system that, whether we want it to or not—and we do not—leads many people to take their own lives.
Among those people are the most vulnerable groups. Other speakers in the debate will, I am sure, highlight young people and their disproportionate increase in imprisonment. It may be true that you could reduce overcrowding and still have a problem of prison suicides, but it is certainly true that we have to take extremely seriously a situation in which, although 6 per cent of the prison population are women, 15 per cent of the suicides are among women and more than half the incidents of resuscitation following attempts on people's own lives were of women. We have to take extremely seriously the fact that things happen to people in prison that are very traumatising, as the statistics produced by the noble Lord, Lord Rosser, illustrate clearly. That is one reason for the fact that being released from prison can often be as traumatic as being put into prison.
What the noble Lord, Lord Rosser, said bears that out and it was important for us to hear it, because I do not subscribe to the view—I hope that nobody else much does—that the Prison Service is staffed by people who do not care or go to endless trouble to try to deal with the matter. I hope that nobody will suggest that the Government and the Minister do not care, or that the outgoing director-general of the National Offender Management Service did not care about the issue. I had the opportunity of conversations with him, and I know that he cares about it very deeply. But it is extremely difficult for people in such positions to make the point that has, with regret, to be made—that most of the people for whom the Prison Service has responsibility have a history of falling through all kinds of nets, not being noticed in all sorts of ways, and having endured treatment that the rest of us would find extremely difficult to tolerate. Most people in prison have been the victims of crime. That is something that we need to keep telling ourselves. Of those who have not, certainly a vast number have been the victims of neglect and abuse that may fall short of the criminal, but probably not very far short.
We need an approach to the issues on every possible front available. Of course we need to give more training to prison staff; of course we need better systems for watching people, particularly in those vulnerable early days and hours and of course we need to be sure that we do all we can to bear down on prison overcrowding; I shall come to that in a moment. It must be the case that overcrowding induces stress and places stress on regimes and on the system generally.
Perhaps I may ask noble Lords to accompany me in their imagination into Brockhill Prison for women in my diocese on a day following two suicides in close proximity. I am sitting in the governor's office with the governor and the chaplain. I am the only man in the room. The place is besieged by men inspecting the prison to find out why the suicides occurred. Not surprisingly, the two people whom I am with are suffering a huge crisis of morale and of self-examination. I believe that chaplaincy plays an enormous role in helping people to come to terms with suicide, which is, as we all know if we have experienced it with friends or family, an extremely aggressive act which leaves a terrible mark of guilt and self-disesteem.
Noble Lords may wish to accompany me to another prison in my diocese—Blakenhurst Prison—where there is good news. Immediately following the terrible tragedies of three suicides in that prison, the chaplaincy team of all faiths were active together in supporting demoralised staff afflicted by terrible self-doubt. I watched that work going on. Chaplaincy has a very important role in this regard because chaplains are seen to represent an alternative authority, an alternative system and an alternative perspective on life that enables people to speak of what is in their heart, whether they are staff or inmates.
It is extremely important that we consider this matter. If people committed suicide in your village or town in the same numbers as they do in prison, that village or town would, by now, be in crisis. The fact that we do not see this as a crisis suggests to me—this is perhaps the most serious matter of all—that we are not taking the people concerned seriously enough. That is the most important indictment that we could face.
We must be very aware of the slipperiness of the language of last resort which is often used in relation to prisons. When we say that prison is a last resort, we may mean that we use it for people for whom our imaginations have run out, or we may mean that we simply have not got round to thinking of something better to do. It may be a last resort and it may still be unacceptable for some—indeed, an increasing number—of the people whom we send there. I very much welcome this debate and I hope that from it will come a renewed sense of urgency about this issue.
My Lords, first, I thank the noble Lord, Lord Dholakia, for initiating this important debate. I declare my interest is chairman of the Prison Reform Trust, and I believe that the chance to discuss this grim subject could not come at a more opportune time.
No matter where you stand on the subject of the efficacy or otherwise of a prison sentence, you would be hard pressed now to say sincerely, "Prison works". With the prison population at an all-time high, with an average of something like two suicides a week, with self-harm rife, especially among young prisoners and women, and with, crucially, the whole system reaching saturation point, how could you claim that "prison works"? Patently, it does not. After all, three-quarters of young men released are reconvicted within two years. It is not working for them and it is worth remembering that it is not working for those against whom they are reoffending.
Today, I want to look at just one aspect of this failure to "work" which I think is crucial to any effort to improve the situation. Efforts are of course being made. After all, no government wish upon themselves a situation as dangerous and potentially explosive as this. It seems to me that we fail at the very outset of a prisoner's sentence; that is assuming—and I hope I am right—that there is a real wish always to rehabilitate and not merely to incarcerate our prisoners.
When prisoners receive their sentence, they receive their punishment. This should not mean that they lose their rights as members of our society or as human beings entitled to decent and humane treatment by the rest of us. As it is, one of the most potent symbols of inclusion in society—the right to vote—is automatically removed on receipt of a prison sentence; an aggravation of the punishment which I believe to be unjust and pointless. I do not expect that this deprivation is high up on the prisoners' worry list on arrival in prison. There are other more pressing matters such as the squalor of sharing a cell built for one with another prisoner. But the fact is that the signal is sent that you are on the outside while you are inside.
As your Lordships will know, the Grand Chamber in Strasbourg ruled on
While I recognise that this is not an easy issue and that there is a case for a continuing ban on the most serious offenders, I urge the Government to give constructive and welcoming support to the judgment and to get rid of the total ban on voting by prisoners, which is a signal of exclusion, and to set about looking for ways of assuring prisoners that our objective for them is their inclusion in society as rehabilitated and responsible members of it. If they do, it might just be—and I am sure entirely coincidentally—that there is an upsurge of interest from Westminster in the condition in which prisoners live. There might just be a consequent improvement in conditions and there might be an improvement in the ghastly record of suicide, self-harm and reoffending, presently afflicting our prison population.
My Lords, I, too, thank the noble Lord, Lord Dholakia, for initiating this debate on such an important subject. I have spent much of my career studying suicide and I feel that I know more about that subject than about prisons. However, I hope that my comments will be of interest. I want to make four or five points on suicide and then four or five about the implications for suicide in prisons, the concern of this debate.
First, suicidal actions are emotionally complicated. One might think that suicide is about death and of course it is. But suicide is nearly always about life. It is about punishing people; it is about expiation; and it is about making an impact on people who are alive. It is not just about death. One must make a clear distinction between the deep emotional causes of suicide and the precipitating factors. That is very important in prisons.
The precipitating factors may be amazingly minor compared with the varied emotions. There is an interesting study of people who have jumped off the Golden Gate Bridge. If you jump off that bridge, you are likely to die—it is a long way to the bottom. But a handful of people, through some kind of vagary of entering the water at a certain trajectory, have survived and have been interviewed. One said, "I jumped over the bridge and as soon as I was on the way down I thought I could have solved my problems". Someone else jumped over the bridge because she had boyfriend problems. However, these are not the true causes of the suicidal actions.
Secondly, suicide always presumes the intent to die. If you walk into the road and are accidentally knocked down by a car and die, that is not suicide. However, the intent to die must always be inferred afterwards. Suicide is one of those actions where you cannot ask the person why he or she acted as he or she did. That means that suicides must be identified by coroners on the basis of inferences made after the event. Most suicides do not leave notes; only about 30 per cent of them leave notes.
I have been studying this for many years and I have come to the conclusion that suicide rates are, at best, extremely problematic. Suicide rates look like hard data; they are not. They depend on inferences. Those inferences are made from circumstances where the judgments of coroners are known to vary wildly. That includes coroners who consider prison suicides, as well as other suicides in the country. So please do not place too much credence on suicide rates or draw too many inferences from them, because you will be wrong. They are not like death rates; they are very different.
Thirdly, depression and mental disorder has been mentioned. It is an important indicator of suicidal risk, but, even so, it is an indicator of only a small proportion of suicidal risk. Most people who are depressed do not commit or attempt suicide, even if they have been chronically depressed. Most suicides have no record of chronic depression. It is a mistake just to study suicide, whether in prison, or anywhere else. You must study suicidal behaviour, which is a much bigger category. There is a difference between suicide, attempted suicide and self-harm. There are connections between them but they are essentially different populations. It is important to recognise that. Rates of attempted suicide, if you trust rates at all—as I said, you must be very careful about them—appear to be about 20 or 30 times as high as rates of actual suicide. The populations are different. Far more women attempt suicide than men; whereas male suicide rates, if you trust them, are higher than those of women. They are not the same populations. Self-harm is an even more distinct population which merges only to some extent with the others.
That is very important because many suicidal acts are not committed by people with the intent to die. They are more complicated than that. In many attempted suicides and, indeed, in some real suicides, there is essentially a gamble with death. A woman will take barbiturates at about the time that her husband normally returns. If her husband returns, she is saved; if not, she may die. It is amazing how many people take barbiturates without checking their impact. They take those things but they do not know how lethal or otherwise they are. Your Lordships probably know the well known joke. Someone jumps off a 24-storey skyscraper and at every window on the way down people inside at each level here him say, "So far, so good. So far, so good. So far, so good". He misinterpreted the nature of risk, because he was going to die. There is no risk. But in many kinds of suicidal actions, the use of risk is a means of demonstrating something both to yourself and to other people.
Finally in this catalogue, institutional suicide has different characteristics from suicide outside. There is the well known phenomenon of contagion, for example, in institutional suicides. You often get clusters of suicidal actions that happen at a particular time, where there is a copycat thing. It is often copycat in method; sometimes it is copycat in place. For example, if there is a high roof from which one person jumps, a cluster of people may seek to do so.
What are the implications? To some extent, they are lethal for the arguments that have been deployed so far. I agree with their content but not at all with most of what has been said about their relationship to suicide. First, during the past couple of weeks I read a lot of the literature on prison suicide. There are wild generalisations there—I fear that some of them have been repeated here—that are either false or depend on unknowns. For example, there is a report that says that suicide among young men in prison in Britain is 18 times higher than in the general population. I very much doubt that. We have no studies that compare like populations. Prison populations include a lot of young men who are mentally ill, as has been said, who have drug problems, who come from poor backgrounds and who have a whole range of other problems. We could only know if we compared them with other men who had those problems in the wider population. It is no good comparing it with the ordinary suicide rate of young men. A lot of the claims that are made about suicide in prison are spurious, or at least highly dubious in their content.
We must give attention to institutional factors in suicide. The moral condition of the institution is often as important as the individual risk assessment, and it is often more important. In relation to what has been said today, respect is often the key. But not respect in the way in which the Government want the agenda—that is offenders to give respect to others—but others to give respect to offenders in the context of the prison.
There is no way that you can prove that overcrowding leads to higher suicide rates; at least I do not see how you can possibly prove it. We just do not have the data on that. It is not likely, because what we know of suicide across prisons in different countries is that isolation is much more dangerous than being in a cell with other people. The worst thing you can do for a new offender is isolate them rather than putting them in a cell with other people. I doubt whether that connection is there, and even if it there, it is not demonstrated.
We have a lot of studies of risk profiles that have been done in prisons around the world. As was said, one of the most dangerous periods is the first few weeks in prison. The reason for that is confinement shock. What stimulates suicidal behaviour is often not oppressive conditions—it is wrong to say that. It is change; it is being introduced into a new environment. That is why the point made by my noble friend Lord Rosser is so important.
Finally, do not expect too much of the Minister. I looked at a report in 1919 on suicide in prison. It raises all the same issues; the suicide of young men, claims that suicide rates are going up, overcrowding in prisons, and so on. Those are endemic issues. I have two questions for the Minister. Why are so many mentally ill young people sent to prison when they really should be receiving psychiatric care? Why do you not concentrate more on the nature of prisons and institutions rather than the individuals in them if you want to change some of these forms of self-destructive behaviour?
My Lords, I begin by joining those who have congratulated the noble Lord, Lord Dholakia, on initiating the debate, and I salute him for the breadth and wisdom of his initial contribution.
I come to this subject with no great pleasure, particularly as in my time as the Chief Inspector of Prisons the subject of overcrowding came up over and over again, as did unfortunately the rising number of suicides. What concerned me about overcrowding was not just the number of people who were held in cells that were not designed to hold more than one, but the effects on the whole prison system, in that overcrowded prisons meant overstretched staff and that the resources that were needed to help people to come out and not reoffend were so choked that people were denied anything to do. So the overcrowding is to my mind just as important in terms of its effect on the regimes and therefore on the protection of the public by preventing reoffending than merely the number of people in cells.
I have two quotations from other people. Once, when inspecting a young offender institution in Warwickshire I had the great pleasure of finding one of my ex-corporals who had been with me in Belfast, who was the receiver for juveniles coming into custody. I asked him, "If I could wave a magic wand, what would you for?" He said, "Time. We are run off our feet, and we do not have time to give to these young people. Twenty minutes talking to some of these young lads as a responsible adult male is probably more important than anything that is going to happen to them". I should like to draw attention to the word "time".
Secondly, the leader in the Guardian of
"There is one clear lesson from earlier prison overcrowding crises. They cannot be resolved by a building programme. That approach has been tried by both Conservative and Labour administrations with disastrous results".
It has been described like putting another lane on the M25 that merely gets filled up as soon as you have done so. The article continues:
"There were three main drivers of this process. First, prison became a political football between the two major parties. Each tried—and still does—to sound tougher than the other. Criminologists have documented how tough political rhetoric at the top feeds down to sterner sentences from the bench. Second, a succession of ever more punitive criminal justice laws ratcheted up the numbers who were put away. Third, both politicians and the judiciary were egged on by feral tabloid press campaigns".
Am I alone in being upset and concerned that the Prime Minister's understandable wish to be tough on crime and tough on the causes of crime seems to have become distorted by an "R" that he has found on a carpet in Downing Street? He now appears to want to be tough on "causers" of crime, which is not the same thing at all. I am disappointed that last week the Prime Minister criticised the judiciary and called for anti-social behaviour orders for 10 year-olds, which wound up that feral tabloid press, which will wind up the public, which will wind up the Prime Minister and ratchet the whole thing up more. Can we please have some consistency?
I applauded what the Home Secretary said to the Prison Reform Trust on the need to tackle re-offending and to deal with individuals as individuals. Yet almost immediately afterwards he suggested that the Probation Service, which of all services deals with individuals in the community, should be privatised. That would undermine the ability to deliver community sentences, which are needed as an alternative to custody. Please may we have consistency?
The leader also states:
"The end result is that now we have more prisoners per head of population than some of the most repressive foreign regimes, such as Burma, China and Saudi Arabia . . . Prison only exacerbates these problems [faced by prisoners]. It breaks the three key bonds that help people go straight: one-third lose their homes, two-fifths contact with their families, two-thirds their jobs".
Often, when crises arise, people say that they do not know the facts. This week the Prison Reform Trust published a wonderful document called Bromley Briefings, to which I draw noble Lords' attention. I suggest that they put it on their required reading list. Toby Bromley, who enabled it to happen, was a remarkable man who wished the public to know the facts. The facts are here:
"This briefing has been produced to provide clear, accurate information on the state of our prison system and the lives of men, women and children within it . . . While this briefing presents facts and figures it is not merely about numbers. It is designed to prompt a response to people held in our least visible, most neglected, public service".
I feel ashamed when I look at the briefing because it describes what is happening in our prisons—in an allegedly civilised country—which has been known about for years, yet we seem helpless to do anything about it. But are we helpless? The year 1919 is mentioned, and I could go back to 1776 and the state of our prisons, but I shall refer to two documents. One was published by the noble and learned Lord, Lord Woolf, following the riots in Strangeways. He says:
"On the evidence, prison riots cannot be dismissed as one off events, or as local disasters or as a run of bad luck. They are symptomatic of serious underlying difficulties in the prison system. They will only be brought to an end if those difficulties are addressed".
As a practical soldier I know that dealing with people requires things with people involved, looking after people. What worries me about current government initiatives, such as the National Offender Management Service—I wish that it were called the National Offender Management System, as that it is really what it is all about—is that they seem to treat people as commodities, which they are not. The service deals not so much with the management of offenders but with the management of the management of offenders.
The only White Paper ever published on prisons, Custody, Care and Justice, in September 1991, following the Woolf report, said:
"The White Paper recognises, as the Woolf Report recognised, that a better and more stable prison system requires a coherent and consistent strategy for the Prison Service. This White Paper provides such a strategy".
It lists 12 priorities, of which three are:
"To provide active and relevant programmes for all prisoners, including unconvicted prisoners. To end overcrowding. To develop community prisons which will involve the gradual realignment of the prison estate into geographically coherent groups serving most prisoners within their area".
If only that strategy had been followed, which it has not, we might still be having this debate today, but I suspect that we would not be faced with these dreadful figures. If the Government wish to do something about this, I beg them to stop imposing on the time of people who are trying to deal with prisoners and having to sort out systems and bureaucracy. All that NOMS has achieved so far is two additional layers of bureaucracy, effectively cutting the budgets of the Prison Service and the Youth Justice Board by requiring money for it, and demolishing and demoralising the probation service. I am very distressed to have to stand here and say that.
My Lords, I am grateful to the noble Lord, Lord Dholakia, as ever, for his long-term commitment to this cause. There is no dispute between us today that the penal system is not in good shape. It is not in good shape ethically, and I thank the right reverend Prelate the Bishop of Worcester for dealing with that so effectively. It is not in good shape to deliver its outcomes, as a place to work or to protect the public. Much is going wrong.
The noble Lord, Lord Dholakia, mentioned the report of the Joint Committee on Human Rights on deaths in custody. In that report, the Committee stated:
"We are convinced that inappropriate reliance on the prison system is at the root of many deaths in custody. Many very vulnerable people are being held in prison unnecessarily, with no benefit to society".
I shall devote the rest of my remarks to the phenomenon of inappropriate reliance. Why is this happening? Why are prisons full of those who everyone agrees should not be there? I suggest this outcome is a direct result of Home Office policy. There are a number of areas, mainly in the towns and cities, where a range of social problems is concentrated: low incomes, dysfunctional families, drugs and mental illness. Research from Scotland shows that one quarter of Scotland's prisoner population comes from 53 council wards. One in four of the Scottish prison population comes from wards where only 7 per cent of the population lives. It is no surprise that these wards are also the most deprived in Scotland. I am sure that similar research could be done here, and maybe that is what we can glean from the welcome contribution from the noble Lord, Lord Giddens. The prison population is a highly selected population.
The Home Office, through its penal policies, has become the repository for the social, health and community problems that local areas feel they do not have the resources to solve. Local services are hard-pressed and when people are sent to prison the Home Office pays. The biggest psychiatric hospital in the United States is not a hospital at all, but the Los Angeles county jail. It holds 3,400 mentally ill prisoners. We have not gone down this road as far as the United States, with prison as the default welfare and health service for the most poor and disadvantaged people, but we are moving in that direction.
At every point, Home Office policies encourage rather than discourage taking the criminal route. People in great social distress commit minor crimes. We can choose to deal with the social distress, or we can follow the crime route. If we keep doing this we shall need many more prison places, because the number of people who can become eligible for courts, sentencing and prison in these deprived areas is large. Once imprisonment enters people's lives, it will continue to be their fate, and will spread to their family members.
How does the process of shovelling into prison large numbers of the more deprived members of deprived communities work on the ground? The Home Office policy called "Narrowing the Justice Gap", which actually means more prosecutions, is one pathway to inappropriate punishment. Instead of putting in place systems to divert vulnerable people from arrest and charge towards mental health and drugs services, it gives the police targets to arrest more, charge more and bring them to justice—although the policy does violence to the meaning of the word "justice".
The next place to divert vulnerable people is the court. That depends on regular probation officers knowing the magistrates; knowing the area; earning the trust of the sentencers; and working co-operatively with the local authority and all the local agencies that can deliver services that will socially reintegrate people. In their policies for probation, the Government have taken a completely different path and required the service to put its main energies into enforcement, into risk assessment and into seeing people in city-centre offices and dealing with their problems in isolation from their social setting.
The gateways to prison need to be harder to get through. The gatekeepers need to be able to provide a better answer. There has to be a service at a local level—not national or regional—level, with a network of relationships based on trust, not contracts, and on long-term co-operation, not competition. For those reasons, the Home Secretary's plans for the probation service fill me with dismay, and I imagine that prison governors are similarly dismayed as they envisage the increasing numbers that will come their way. Soon, if we take that route, we will have 100,000 prisoners, many of whom will have been inappropriately locked up.
Last week, I had the privilege of visiting Holloway prison. Noble Lords might be surprised to hear me say that I found it an inspiring place, run by an exceptionally dedicated governor who is surrounded by many enthusiastic, talented members of staff. If the Government's policies were as good as those staff deserve and if the constant flow of desperate women who need care not punishment were stemmed, those staff would have a chance to realise the vision set out by the Home Secretary in his Prison Reform Trust speech on
I do not intend to ask the Minister any questions of my own, although I am grateful to her for, for the first time ever, giving me a reply the last time that I asked some questions—it was well received. However, I hope that she will answer the questions asked by the noble Lord, Lord Giddens.
My Lords, the noble Lord ought to observe the proprieties of the House. If he wishes to comment on the subject, he should speak in the gap, if there is time.
My Lords, I welcome the opportunity that the debate affords us to raise profound questions and concerns about the use of custody for children and young people and its consequences for us all. I declare an interest as chair of the Children's Society.
I imagine that we would all regard the recent increase in the use of custody for children as one of the most alarming developments in youth justice. Since 1992, custodial sentences for children have increased by 90 per cent, and the number of child suicides since 1990 is 29. We appear to have a somewhat schizoid approach to the problem. On the one hand, we have a welfare and protection system that is based on ensuring that children are safeguarded and their needs met, an approach that is being strengthened through the Every Child Matters agenda. However, as soon as the child crosses the line into criminal activity, the approach all too quickly becomes one of punishment and retribution. The purpose of the youth justice system is to prevent reoffending. As a result, there is inadequate consideration of the welfare of the child, which results repeatedly in the placing of vulnerable children in prison settings.
Concerns have been raised about conditions for children and young people in prison from various quarters—some have been referred to in the debate—including the United Nations Committee on the Rights of the Child, the Joint Committee on Human Rights, the Chief Inspector of Prisons and, most recently, the Council of Europe. The Children's Society concurs with the recent recommendation from the Joint Committee on Human Rights, which wrote:
"We urge the Government to re-examine, with renewed urgency, sentencing policy and practice (and in particular the use of detention and training orders) and alternatives to custodial sentences, with the specific aim of reducing the number of young people entering custody and with a commitment to implementing Articles 37(b) and 40(4) of the Convention to the fullest extent possible".
I shall explore the difficulties involved in finding alternatives to prison for young people. A young male aged 15 or over sentenced to a detention and training order will almost certainly serve it in prison. The court has no power to direct that a detention and training order should be served in any particular type of secure location, regardless of whether the young person has already been assessed as being or is otherwise evidently too vulnerable for prison. It was over that dilemma that the judge in the case of Joseph Scholes deliberated for 19 days in reaching a decision on sentence. The availability of placements in secure accommodation is a critical factor. Whatever the outcome of a vulnerability assessment and professional judgment, it is the availability or otherwise of an appropriate placement that will determine whether a vulnerable child is relieved of the pressures of penal custody.
Prison Service accommodation is cheaper, and that presents a major challenge to the aspirations of the Youth Justice Board. Perhaps the most crucial factor that enables prisons to be so cheap in comparison with other options is the staff ratio. Local authority units provide a ratio between one member of staff to every two children and three staff to four children. The ratio in secure training centres varies between 2.5 and 3.8. Prisons, however, average between 3.4 and 6.6—by far the lowest staff-to-client ratio of any child placement of any kind in any sector.
The consequence is that the number of vulnerable children detained in young offender institutions has risen from 432 in 2001 to 3, 337 in 2003–04. The vulnerability of the young people in Prison Service custody has been well documented. Some 60 per cent have previously been looked after by a local authority; 85 per cent exhibit signs of personality disorder; and 25 per cent of males have suffered violence at home. It is estimated that, at any one time, there may be as many as 300 young people in prison who are in need of transfer to in-patient mental health provision that simply does not exist. The recent Safeguarding Children report raises concerns about the vulnerability of young people detained in young offender institutions and highlights serious levels of bullying and assault and a high risk of harm. In recent research published by the Children's Society, over 100 children, staff and prison officers were interviewed about the vulnerability of children in prison. The research sends out a clear message that prison is a dangerous place for children and highlights the lack of faith that children and staff have in the ability of the prison system to support and protect them.
The fact that Joseph Scholes, Adam Rickwood and many other young people like them found themselves in Prison Service custody at all is testament to the problem that we face. Children are not being treated as children; they are not being given the help and support to address their welfare needs and the underlying problems that lead to their engagement with a criminal justice system that is no place for them. The Youth Justice Board has recently produced a strategy for custody for children. It aims to reduce the use of custody for children by 10 per cent by March 2007, which is, of course, to be welcomed. I urge the Government to consider that in their forthcoming and eagerly awaited youth justice Bill.
I would call on the Minister to make a commitment, first, to end the use of Prison Service custody for children and young people; secondly, to reduce the numbers of children and young people sentenced to custody; and, thirdly, to invest in alternative secure options for the small number of children and young people considered to be a risk to themselves or other people. The juvenile secure estate cannot continue to struggle and, too often, fail to meet the needs of children and young people, many of whom are extremely vulnerable, the result of which can too frequently be their deaths. That is a risk too far for all of us.
My Lords, I, too, thank the noble Lord, Lord Dholakia, for enabling us to have this important debate. I also remind your Lordships that I have the privilege of chairing the All-Party Penal Affairs Group. In June, 16 people killed themselves in our prisons, which is the highest number for any month on record. Last year, 95 people in prison took their lives, which is equal to the highest number for any calendar year since records were kept.
The risks of suicide in our prisons are known and recorded: one-third happen in the first week of custody; one in seven happen within the first 48 hours of the cell door slamming; around two in every three prisoners who commit suicide have a history of drug abuse; one in three of alcohol abuse; and seven in every 10 have a history of mental disorder. Those things are known and the system totally ignores that evidence.
I welcome, as does the Prison Reform Trust, the new programme to try to prevent suicide being phased in across the Prison Service. It involves considerable specialist training, which can only be the more difficult to achieve alongside massive and growing overcrowding. The growing shameful and shaming number of prison suicides has its roots in alcohol and drug misuse problems and a high incidence of mental disorder. But it also raises a larger question which must be answered. Is prison really the best place for prisoners with those known predictors of destructive self harm? Prison staff, however well trained, are simply not equipped to offer the specialist help and treatment that those vulnerable prisoners need.
Instead of building new prisons and then struggling to isolate wings to better handle those with known needs which point to serious self-harm—overcrowding drowns those good intentions—we should build secure hostels where health and medical professionals can more effectively deal with the known needs which lie behind the offence. Surely, that is a better way of trying to reduce self-inflicted deaths and to reduce reoffending.
Reoffending rates—one of the main reasons behind overcrowding—demonstrate the expensive failure of our prison system. Mr and Mrs Joe Public are not getting any value for money for the £37,000 a year that it costs to lock someone up, when more than seven in 10 offenders are back inside within two years. Overcrowding assists reoffending because it denies too many prisoners any proper chance while inside of taking advantage of schemes to deal with alcohol and drug abuse or to learn useful skills.
Our prisons lock up 78,000 men and women, which is set to reach 90,000 in five years. Who are they? In July, 12,953 were on remand, not sentenced or awaiting sentence. That is one in six of the total prison population. Almost one in five of that number will be acquitted or not proceeded against and eight out of 10 of them face non-violent charges. Is that the most sensible use of expensive prison places? While the number in prison expands, the numbers of those sentenced by courts has fallen over the past decade. More people than ever before are sent to prison by magistrates and Crown Courts. Why do so many magistrates send one in five people found guilty of non-violent shoplifting to prison, which is nine times as many as in 1993? I simply refuse to believe that there are no community punishments available to deal with shoplifters. Overcrowding is made worse by short sentences of fewer than six months for all but a handful of those sentenced for non-violent theft and motoring offences.
The alternative of proven, well funded and targeted non-custodial sentences is not only cheaper but also can give the offender a longer period to take advantage of the help on offer while keeping up family and social links. I suggest that the public have no idea of the problems which prison officers face—some of which have been referred to. Forty-seven in every 100 men and half of the women in prison run away from home as a child; just over one in four were taken into care as a child; one in three truanted from school; and 52 in every 100 men and 71 in every 100 women have no educational or skilled qualifications. Unsurprisingly, 67 in every 100 prisoners were unemployed when convicted.
That is not to make an excuse for criminal behaviour. It is a plea to better understand the roots of offending and reoffending in order to increase the chances of finding a variety of ways in which to deal with it and to decrease the chances of reoffending. We need sensible boldness in our prisons, not tacking on the odd new shed and the odd fence here and there. No one can be satisfied at the moment with a system which expensively fails to achieve so much at such a high and rising cost.
Gaol should be only for that minority of offenders who are convicted of the most serious and violent offences, with specialist secure establishments for those in need of a range of health and other treatments. Community sentences should be more widely used to address the offence and the education, training and other needs of the offender, again, to reduce reoffending and help to encourage them to become useful members of society.
Earlier this week, Erwin James, who, towards the end of his 20-year sentence in prison, began writing a column for the Guardian, described to a meeting of the Prison Reform Group how he had used his time in prison to help himself and to educate himself up to degree level at the Open University. He said that most prisoners need educators rather than gaolers. I ask the Minister to think about that. He told openly a very moving story of the positive way in which he had been able to handle his sentence. The pity is that he is an all too rare person in a system more used to expensive failure than personal, social and community success.
My Lords, I, too, thank the noble Lord, Lord Dholakia, for introducing this debate today. We spoke not long ago in a debate on deaths in custody. I will not repeat some of the things that I said then. I speak from the vantage point of being a psychiatrist who has had much experience of people with suicidal behaviour. I also chair a strategic health authority in London, which is now responsible for the performance of primary care trusts commissioning mental health services in prisons and mental health trusts which are meant to deliver it.
We have had an excellent academic seminar from the noble Lord, Lord Giddens, on the causes of self-inflicted deaths. I shall not repeat everything that he said. He is absolutely right, except in one respect. I do not share his therapeutic nihilism about what needs to be done, but he underlined what others have said; namely, that we are importing into prisons now a population of which 90 per cent has a diagnosable psychiatric condition. You cannot separate out self-inflicted deaths from the provision of healthcare and mental health services to that population. But that is a crazy way to have to do it.
On the face of it the Government have invested quite phenomenally in this area in the past five years. They have transferred the prison health service to the NHS, and it has been progressing for the past four years and has made substantial progress. The cornerstone of the comprehensive primary care service, with rapid access to specialist mental health professions has happened, in part. In-reach mental health teams—a sort of community team in prison—are now active in 94 prisons, with more coming on stream. There are 300 extra NHS staff employed to work in prisons. We have had excellent work in producing the Offender Mental Health Care Pathway. There are excellent templates of good practice from pre-prison custody through reception and acute care to release. It is all wonderfully constructed, great stuff. There is excellent partnership working between agencies, the Home Office, the Department of Health and external agencies.
So what is the matter? Why is it so difficult to effect change in prisons when we know what is known about the correct approach, and when there is unprecedented senior management effort and ministerial concentration on this dilemma? Either the strategies are ineffective, which I do not believe they are, or the strategies are effective but management is under the impression that they have been implemented at local level when they have not, or the strategies are implemented but the sheer numbers of vulnerable individuals at risk makes for a high failure rate. I think it is here that the correlation, if not the direction of causality, is necessarily established between overcrowding, staff attention to the matter and the risk of self-harm being so high. Lastly, there may be extraneous and diametrically opposing policies of setting improvements in other aspects of prison care and some of them have been mentioned here. I suggest that the problem is a combination of at least three of these.
The strategies might work if they ever got a chance. They are implemented on a minute scale. There are too few people trained to understand them. In-reach teams that should spend most of their time training staff and working with people directly on a 24-hour basis are usually 9 to 5-type teams. They are inundated with work with 10,000 people with severe psychosis currently held in prisons. Such highly disturbed prisoners are waiting for beds outside, but many of them will never have an opportunity to get into one.
We have heard many good things about the governors and senior staff behind these efforts, and there are many psychologically-minded prison officers too. But there is still a small group of deeply unsympathetic and influential prison officers who undermine attempts at cultural change in some local prisons. Tackling that culture and introducing a therapeutic and, I strongly agree, educationally-based regime is not a soft approach, but a tough approach that is paternalistic in the best sense. However, it is being undermined in some respects.
We have heard about the number of people coming through the system and I remind noble Lords that they are constantly on the move. Establishing therapeutic relationships is difficult enough in the first day or the first week, but when people are constantly on a merry-go-round and disappear overnight to some prison without any communication of psychological information, how on earth does one do it? Our mental health teams are constantly saying, "We were getting there, and he disappeared". Why does the Prison Service seem to believe that moving people around is essential or, perhaps, beneficial? It looks completely crackpot, given the population in its care.
Finally, I have a proposal. There are many similarities between the Prison Service and the National Health Service. They are both centrally directed bureaucracies with executive chains of command and vast distances between the top and the bottom of the hierarchy. Even private prisons often have a similar distant chain of command. I have noticed that to tackle cultural change in the NHS one needs far greater local accountability. That requires not just good and visionary local management, but also using people who are in a non-executive role, such as chairs and independent chairs. The best foundation trusts, which keep in mind the need to improve patients' awareness and experience of services and to provide a buffer between the local trust and the central national executive, are those that have excellent locally accountable boards with the input of non-executive staff.
I know very well that the Government have supported the introduction of that sort of accountability in the NHS and are now doing so in the education service. It would be interesting to know whether the Government would consider doing the same sort of thing with the Prison Service. It needs to engage wider talent from outside its usual channels of appointment to improve local accountability if these cultural issues are to be tackled more quickly.
Finally, we have to get to grips with who needs locking up. As other noble Lords have said, when one arm of the Home Office is developing policies to tip more sad and difficult folk into an overflowing system and another arm is working on policies to mop up the human spillage, there is something seriously awry with the overall system.
My Lords, I join in the congratulations to the noble Lord, Lord Dholakia, for bringing to your Lordships' attention a subject that is of enormous importance to this country and to this House. I emphasise that, because I must explain that the reason why I am the only person on my party's Back Benches is that the memorial service for my late noble friend Lady Blatch is at this moment concluding across the way. It was only with the greatest regret that I decided that I should join your Lordships because our duty is to the living. Lady Blatch, of all people, would have understood the importance of this issue.
I am glad to see the noble Baroness, Lady Scotland, with us, not only because of her recent absence but also because she has been concealed from me throughout this debate by the Dispatch Box, even when I have been promoted intermittently to the Front Bench.
There were 95 suicides in prisons in 2004, as has already been mentioned, and 150 people were resuscitated who were presumed to have attempted suicide. The problem is even greater than we sometimes accept. The noble Lord, Lord Giddens, rightly said that the true rates inside and outside prison are probably less different than they appear because the prison population is a self-selecting sample. But whether or not it is, these individuals are so absolutely and completely in the hands of the state and in its care that we have a duty to them.
When I left the post of Minister for the Prison Service in 1982, the average number of prisoners on roll was less than 44,000. It is now over 74,000. So building has not worked. The comparison with building another lane on the M25 is unfortunately a good one. Among that large number of our citizens, why are so many children put into the system? It is entirely wrong, and it was seen as wrong in the 1970s. Governments were forced to undertake to ensure that it did not happen again. As a Minister, I was chasing individual cases of children who should not have been in prison and finding it very difficult to get them out, but they were a handful. Then we have the astonishing figures produced by the right reverend Prelate the Bishop of Birmingham. I would like a response to that because it ought not to be.
The right reverent Prelate the Bishop of Worcester told us that we live in a society that does not find capital punishment acceptable and therefore inferred that society has a similar duty to see that suicide is not acceptable either. I have to tell him with great deference that he is wrong. Society thinks that capital punishment is acceptable, and has said so in frequent opinion polls. It is the state that says that it is not and it said so under the direction of Parliament, of which we are a part. Therefore, I entirely agree with the right reverend Prelate that there is a duty, but it falls squarely on the state and even more squarely on the shoulders of parliamentarians such as ourselves. We, as Parliament, have said that capital punishment shall not happen, even though the public wants it. We have an equal duty to express an equal compassion for people who are minded to take their own lives.
Whatever the precipitating factor may be, I say to the noble Lord, Lord Giddens—who said, "So far, all right" after the sixth minute; "So far, all right" after the seventh minute; "So far, all right" after the eighth minute, and sat down before the ninth—what has died in a prisoner who commits suicide is hope; it has been killed by the institution. Some of your Lordships heard last night a most moving account from a former life prisoner of how this manifested itself in the cell and on the landing; how someone you thought of as a steady, reliable person one day was simply not there the next, and it kept on happening. It happens twice a month.
Is there a direct connection with overcrowding? You can prove it either way. The top 10 prisons for the number of suicides are among the top 20 prisons for overcrowding. On the other hand, 70 per cent of prisoners who died in custody last year did so in single cells. So there is a very complicated argument about how our prisons should be designed and the effect of overcrowding on prisoners.
Perhaps I may latch on to something the noble Lord, Lord Ramsbotham, said on this issue—if I had time, I would simply repeat everything he said before I tacked on my own feeble observations. He pointed out that the pressure falls intolerably on the prison officers whose duty it is to look after these people. It prevents human and humane contact. When people go into a prison they do not go into a machine and they are not a commodity; they are people. They are as precious in the eyes of God as are your Lordships—in fact, many would argue more so—and that being the case, we have a duty to do something about it.
No doubt the Minister will tell us about what is being done. I should be interested to hear what progress is being made with something called ACCT—which stands for assessment, care in custody and teamwork—because that seems to be about how prisoners are managed as people. But we have to give it more time and more resources—and that means we must somehow reduce the number of prisoners involved.
In my last 50 seconds I remind your Lordships of the theme that I come back to every time in these debates: we ought not be putting so many people in prison because it does not work. The ratchet effect, the winding-up process, says it does—a politician on a platform says, "Prison works", the audience rises to its feet, a government programme is born and the press then builds on that year after year—but it does not work, except for the few minutes or maybe the few years that the prisoner is in. What works is getting to young people before they become prisoners; finding the enormous energy and enthusiasm they have got to deploy on something and giving them something constructive to deploy it on.
That is best done by the voluntary sector. I would like to see the resuscitation of a programme of government funding for voluntary sector initiatives—little ones, all over the place—targeted in run-down estates, where the last pub has closed, where the last shop has gone, where the bus connection is faltering, where the windows are being broken, where the flats are being boarded up. Let us find an adult or two who want to form a jazz band or a rock-climbing team; who want to go white-water rafting or form art, music or tapestry classes—anything. They will transmit freely from their voluntary enthusiasm to young people. In that way success is born, not by locking them up.
My Lords, I add my gratitude to the noble Lord, Lord Dholakia, for introducing the debate so comprehensively.
The figures on suicides in prisons are very worrying. As well as concern about the mental welfare of those who end up in custody, I, like the noble Lord, Lord Elton, who has just spoken, would like to look at the antecedents to them being there, and particularly to being at risk of suicide.
The figures suggesting a five-fold excess of suicide mortality in prisons are alarming, but I would suggest that every suicide is a reflection of society as a whole and that society cannot lay all the blame at the doors of the prisons. Sadly, many of your Lordships have first-hand experience of bereavement from suicide and the plethora of "what if?" and "if only" thoughts which remain unresolved for the rest of their lives.
There is a global trend apparently of increased suicide rates over the past 50 years so that by 2020 there will be a projected 1.53 million suicides a year of all types. It may be that prevention measures in some countries have been offset by huge rises in developing countries, such as China and India, but the inaccuracies of classification of deaths makes it difficult to assess.
But let us focus on England and Wales. A recent study of prisoners in the past 25 years by Seena Fazel and colleagues is important because it reports a rise across all ages, with a particularly striking excess in young boys aged 15 to 17 years. It is this group that I want to focus on.
It is known that severe emotional stressors, including traumatic bereavement in childhood and adolescence, are linked to offending and maladaptive behaviour. A family history of suicidal behaviour, a history of psychiatric hospitalisation and symptoms of anxiety or depression are independent risk factors for suicidal ideation in prisoners, and prisoners with suicidal ideation have a higher risk of self-destructive acts in the long-term after discharge from prison.
In 1998, a Cardiff prison medical officer, Dr Nick Jones, and I tried to find out if bereavement was linked to people ending up on remand. With an occupational therapist and four nurses, he tried to discover whether the young offenders on remand in Cardiff had a higher incidence of unresolved grief than others in the population. They had noticed that some of the remand prisoners seemed the most emotionally vulnerable and had a history of traumatic bereavement. The prison authority wanted to be helpful but was very frightened that even asking a question about past bereavements might precipitate a suicide. So it was agreed that only those prisoners who came to the medical services for any reason were given an information leaflet, assured of confidentiality and offered an interview. Those with a history of bereavement were invited to a semi-structured interview, conducted with great sensitivity by these very motivated staff, and were offered a series of support sessions.
Among those wishing to attend the support sessions, more had witnessed a violent death, felt that they had not coped well with the loss and had more pointers to depression and suicidal ideas. Many of these young men described traumatic bereavements. For example, three were bereaved through suicide; one was in a car crash that had killed his girlfriend; one prisoner's baby had died and another's girlfriend had had a fatal pulmonary embolism, linked to the conception that she was taking, after his imprisonment. Sadly, none of those taking up the offer of support sessions completed them for a variety of reasons, often being moved on by the system.
If we live in a society that does not adequately recognise the disastrous effects of loss and bereavement on young people, that does not provide them with any haven of safe support where they can resolve their grief, where can all that anger and chaotic emotion of bereavement go? If all that anger is unfocused, it is hardly surprising that it turns against the society that has not supported them and ends up in criminal activity. When in custody the unresolved grief and the depression that goes with it become high risk factors for suicide.
But it is also well known that those presenting to prison medical services with insomnia and pain are traditionally perceived as manipulating to try to obtain hypnotics or analgesics. I suggest that the prisoners who are presenting thus may be particularly emotionally vulnerable, may have a history of unresolved grief and could benefit from support that does not medicalise their presenting complaints. However, the resources of the prison health service are too stretched to take this on, although voluntary sector assistance could well be harnessed to try to provide some support for those who present with unresolved grief. But until the extent of such antecedents to offending behaviour are linked to suicide, then a better way to prevent suicide will not be developed.
Suicide prevention and prevention of offending behaviour must be linked to providing support to children and adolescents overall. All those, when bereaved or otherwise traumatised in our society, deserve support. Proper bereavement support to children and adolescents must become a routine part of our health and education provision so that every staff member considers the relationship of the dying or dead patient to young people and feels that it is his or her duty, working in healthcare or education, to ensure that children or adolescents are included as part of the family and are important as secondary patients in the bereavement process. Otherwise we are just waiting until those children exhibit offending behaviour. Some of them will, some will become imprisoned and some will commit suicide. It is far too late, then, to be wringing hands.
Perhaps the first step towards would be to adopt fully the United Nations Convention on the Rights of the Child, giving children equal status with adults right across the board.
My Lords, I, too, thank the noble Lord, Lord Dholakia, for securing this debate. I have no experience of working in a prison although in 1985, I worked briefly in an intermediate treatment centre—one of those for which the noble Lord, Lord Elton was responsible—aimed at keeping children out of prison. I am generalising from my experience of work with children outside prison and my visits to prisons.
I agree with my noble friend Lady Murphy about the Government's investment in criminal justice since 1997. I note in particular the reception the youth offending teams have received. I thank the noble Baroness, Lady Scotland, for her efforts and those of her colleagues in persuading sentencers not to use custody and remand for short sentences.
I should like to concentrate on the training, support and supervision of prison officers, especially those working with children. Sir William Utting's report on safeguarding children in children's homes, People Like Us, said—I am paraphrasing—that the best protection for children is an environment of overall excellence. Prison officers are their best safeguards.
Who are these children in young offender institutions? The right reverend Prelate the Bishop of Leicester described them very clearly. I would add only that many are of low intelligence and have experienced interference in their development early in life as well as very inconsistent parenting. They are punished, there is no interest in setting limits for them and then they are punished again. It goes both ways.
The lifer to whom many noble Lords have referred began his criminal career at the age of 10. When asked about children in custody, he said that this was the most challenging group. They strive to act as hard men, to seek respect; they model themselves on the idols of drug and gangster culture. Prison officers have told me that these children are the most difficult to manage. From my own experience, I know it is extremely stressful working with them.
I was recently at an awards ceremony for National Grid Transco graduates from a young offender institution. Thames Water,I think, was presenting awards for graduates' success in training and preparation for employment as water engineers. The young men's mothers, girlfriends and children attended the ceremony, but there were no male relations present. I spoke briefly to the senior prison officer escorting them who said that those young men do not have fathers taking an interest in them. The person presenting the awards saw his role that day as an interested father figure; he talked to the individuals who had been caring for and supporting the young men and could give them feedback about their achievements. I was given a lift back by one of the water engineers who had been training these young men, who said he had never done anything as rewarding in his working life.
The prison officers in young offender institutions whom I have met seem enthusiastic about their work; they have great potential to be the positive role models that these young men lack. This I hear from others who know of them. But there can be 60 children and only four or even three prison officers to a wing. The children spend 100 hours of their week under the direct supervision of prison officers, who could do the most to remedy the problems of the past.
I welcome the Government's introduction in the past year of the juvenile awareness staff programme. It is a seven-day programme to train prison officers, who then train other prison officers, on matters such as child protection. It comes very, very late; it is only the initial stage in developing the awareness that is necessary for vulnerable children, but I welcome it.
I am concerned that staff should receive better supervision for working with vulnerable children. In the social care and healthcare arenas, such staff should receive regular individual supervision from an experienced practitioner to ensure that they are doing what they should be doing and that they reflect on their practice. This is the means of relieving officers of the stress of working with such vulnerable young people, helping them to understand what is going on. I cannot say how much it shocks me that prison officers are being put in this situation and children are being placed with them. No wonder there is a hard core of very resistant prison officers. To undergo that experience over a long period of time can brutalise some people. We need to look at how they do things on the continent, where training and support is very professional and the calibre of staff working with vulnerable children very high.
I see that I have gone over my allotted time. I look forward to hearing the Minister's response.
My Lords, I have long thought that there was an overdue case in this country for setting up a broad-based royal commission to look at the whole question of our antediluvian penal system, which is in many respects a blot on the record of a civilised country. I hope that this debate, initiated by my noble friend Lord Dholakia, will encourage the Government to do so, through the medium of the noble Baroness, Lady Scotland. I would be amazed if she were not entirely in favour of such a royal commission; it could strengthen her position in government to argue for it. We have heard about so many of the problems; they can be solved only by a deep study undertaken from all points of view. From my experience—and I do not intend to reminisce—it is long overdue.
My Lords, this has been an extraordinary debate and one which we must all remember. The deaths of people in the "care" of the state are our responsibility and we are all implicated; all responsible. So we must be grateful to my noble friend Lord Dholakia for initiating the debate and reminding us of that.
I declare an interest in that I have had the experience of losing a close family member through suicide—and I expect that I am not alone in the House in that respect. That is what helps me connect with some of the realities of what we are debating, for we risk losing touch with the reality of this subject in the measured words, strategies and statistics, which somehow deaden the enormity of it all. I also have a life-long involvement with working in prisons. Over the past decade or so, despite the talk, initiatives and policies, the problem has grown relentlessly, particularly, and most shockingly, among women and children. We must therefore now become far more aware of the realities and feel the urgency. Then the people in the care of the state might have a better chance of staying alive because it would be at the very top of our agenda. It would inform how we carry out our duty of care to those in custody, and the individual's right to life as enshrined in Article 2 of the ECHR. I fear that we still lack the necessary sense of urgency.
Yesterday, I was told by two senior Scottish Prison Service administrators that they put prisoner life above security when it came to determining priorities in the SPS. We have to learn from them. Although small by comparison with England and Wales—an international comparison of sorts, to respond to the noble Lord, Lord Rosser—the Scottish Prison Service is also suffering from the apparently inexorable growth in its prison population, but its suicide rate continues to fall, in contrast to England and Wales. The perception down here is that as the prison population rises, so inevitably must the suicide rate. We could challenge that perception.
In all the statistics quoted by many noble Lords—bearing in mind the clinical caveats of the noble Lord, Lord Giddens—the ones which stood out were that boys aged 15-17 are 18 times more likely to kill themselves in prison than in the community; that almost 40 per cent of women have previously attempted suicide; that more than half of those who died were on remand and therefore still innocent in the eyes of the law, and that 72 per cent of suicides are by people with a history of mental disorder. Worst of all, in August 2004, a 14 year-old killed himself in a secure training centre—the youngest ever. That reminds us that the Prison Service has a massive job in dealing with desperate and desperately disturbed people, but that on entering prison and in our care those people are at greater risk of dying.
One last statistic, which defies my imagination, is that 228 prisoners were resuscitated by staff last year. That is a task that we should not be asking our prison officers to do. I know and admire many of our prison staff, and my work at the Butler Trust has demonstrated the best of best practice in the awards that we give, including for suicide-related work. They are at the sharp end of what we are talking about, and the need for greater training, expertise and insight into the risk factors as a priority seems inescapable.
The irony is that this has been a subject that has exercised policy makers, practitioners and professionals in the field for many years. We have heard how the inspectorate has been at pains to point out the problems and the need for change, and that a lot of time, money and care have been expended on the issue, as we heard from the noble Baroness, Lady Murphy. The work of the Safer Custody Group bears witness to that with detailed manuals on the management of suicide. However, they do not take account of the bigger picture and the underlying causes. The latest initiative, which is to be welcomed, is Assessment, Care in Custody and Teamwork, which could make an impact—although I am told that the assessment training for prison officers is only one day—but it is not due to be fully rolled out until March 2007. That is too long while people continue to die. In Scotland, a similar and successful system has already been established and subsequently further improved on and refined because it is at the very top of Scotland's priorities.
We all know—and have heard today—that prisoners are a very vulnerable group where mental health issues and drug and alcohol addiction are huge problems for the prison staff which impact on the risk of suicide especially in the early days of incarceration. We know that the first night in custody and the first few weeks are the worst, although lifers are also over represented in the figures at the other end of the scale. But first night initiatives and centres are not in every prison as they should be and the assessment and treatment of drug users currently fails to pick up and stop all potential suicides. Better, ongoing training—which is currently inadequate—must play a part in all this, as well as the understanding that prevention is the priority.
A fundamental issue is that unless and until the culture in many of our prisons changes, until the prevalence of bullying in many establishments and the lack of prisoners sense of being safe is dealt with, the most vulnerable will remain at serious risk. I listened with great interest to the proposals of the noble Baroness, Lady Murphy, on that matter. The major challenge rests locally with governors and senior managers and others in the community.
However, the single most scandalous aspect of what we fail to do for all those in our charge is to keep the children safe. Noble Lords should read the small book to which my noble friend Lord Dholakia referred, "In the Care of the State?", which catalogues the misery and despair of the youngest and most vulnerable of all prisoners and the context of the legal, political and practical issues which accompany them. And now, only last month, the most recent death took place of a 17 year-old in HMYOI Hindley. That makes 29 children, all 17 and under, who have died in our care since July 1990. Their stories make terrible reading, not just their deaths at their own hands, but their histories of self-harm, mutilation, abuse, bullying and distress which had finally become beyond their endurance. This is not a responsibility to live with without doing something about it as a matter of urgency.
I have spoken on several occasions about the unacceptable existence of secure training centres of which there are now four, and which have been growing under our feet during the life of this Government. These are places where we incarcerate children as young as 12—a fact that prison administrators from Europe cannot believe—which are quite simply child prisons. I have visited one where I discovered that a privilege to be earned was a teddy bear. Last year in Rainsbrook Secure Training Centre, a child of 15, and five feet tall died, not, in this case, by his own hand, but by staff in what is called a "double-seated embrace" while being restrained. Not even in the middle ages can such an epithet have been used to describe such an activity. That method has now been permanently suspended, noble Lords will be glad to hear, but it remains the case that physical restraint of some kind has been used on children in STC's 11,593 times.
I, along with every other agency working with children, urge the Minister, whose humanity and intelligence is well known to all of us, seriously to reconsider the continuation of such child prisons, and to invest instead in developing local authority secure units whose provision is nearer home, whose ethos is more on welfare than punishment, which is no more than the rights of the child requires, and where, to my knowledge, no child has ever died. Some may be less than perfect, but commitment and investment could deal with that. I remind the House once again that in Scotland no child ever reaches the criminal justice system until he or she is 16, or even 18 in some cases, for they are dealt with by children's panels in the community where the child's need not his deed is the first priority.
It must be recognised that, in a situation where the use of prison does not reflect crime rates, those now being sucked into the system are increasingly those marginalised and vulnerable people who would not have been in prison in an earlier era when sentencing was less severe. That is particularly true of women and children. What it also means is that prison staff are put under ever increasing pressures, both from the growing proportion of vulnerable prisoners whom they have to deal with and the sheer weight of numbers, not to speak of the churn and the moving on of prisoners about which we have heard. The evidence is that in England and Wales there is still a statistical connection between prisons with the highest overcrowding and the highest suicide rates, as the noble Lord, Lord Elton, said. Unless and until the prison population is reduced to a manageable size, those problems will remain unmanageable in any kind of professional or humane way.
What plans are there to improve staff training, speed up the new ACCT procedures, ensure that first night centres are in every prison, address and stop bullying to create a safer culture and to phase out STCs in favour of LASUs? What is clear is that we have in prison enormous numbers of people who should never be there, either by virtue of their age, their vulnerability or their mental illness. As a result, we have given the Prison Service an impossible task to fulfil—and given some prisoners an experience so inappropriate and awful, given their difficulties and needs, that the system—which means all of us—is killing them. The killing has to stop.
My Lords, I must first apologise to your Lordships and in particular to the noble Lord, Lord Dholakia, for not being in my place when this debate started. My safety factor did not build in provision for a blockage due to a traffic accident. Therefore, I ask leave of your Lordships to address the House from this Dispatch Box.
The noble Lord, Lord Dholakia, has done the House a service in calling this debate, and all of us who have taken part are most grateful. The debate has again highlighted the value to this House of the Cross-Bench Peers—and we have not been disappointed today. After hearing the noble Lord, Lord Ramsbotham, we of us who represent political parties here can feel to some extent up before the beak.
The noble Lord, Lord Giddens, has shown that in a debate of this kind we can beg to differ in an elegant and constructive way. Indeed, whether there really is a correlation between overcrowding and suicides in prison has been the theme running through the debate, but the two subjects are so serious that I choose to assume that there is a connection.
This is a subject that is not short of statistics and, once again, the noble Lord, Lord Rosser, has given us a lesson in producing them in a meaningful way. Anything that I add should be regarded as merely additional, but I start with the statistic that two people a week take their lives in prison. During the past year, more than half the prisons in England and Wales were overcrowded. In 2004, 139 prisons in England and Wales were overcrowded; indeed, according to the Prison Reform Trust there are prisons that are not only overcrowded but at some point have exceeded their maximum capacity. At the end of October 2004, 11 prisons were operating at or above maximum capacity. It is against that background that we have to examine the impact of suicides. A helpful table produced by the Howard League shows that out of 159 suicides in prison since
It is worth mentioning that one of the most insidious causes of overcrowding in prison is the pressure put on some prisons by being required to accommodate remand prisoners, who have of necessity to be located reasonably near the court at which they are to appear. That obviously places a great strain on such prisons and is a major cause of overcrowding, a point to which the noble Lord, Lord Rosser, and the noble Baroness, Lady Linklater, referred. The management of those prisons have frequently to resort to the regrettable practice of churning, whereby convicted prisoners have to make way for remand prisoners, which often entails their being moved some distance away from their families. A debate earlier in the year, instituted by the noble Baroness, Lady Gale, in your Lordships' House, highlighted the particularly disastrous effect that churning has on female prisoners, when their offspring can present additional complications.
I was pleased to hear from the noble Baroness, Lady Stern, some good news from Holloway. Statistics on this prison have been bandied about in previous debates, one of which was that five prisoners have to be cut down each night. I should be very grateful if the Minister, whom we are very pleased to see back in her place after her recent problems, could help us out with that, if necessary through a letter.
A further serious problem of overcrowding applies to prisons receiving prisoners from the courts, where the sheer volume of the prisoners arriving following sentencing in the courts frequently means that there is a shortage of time and space to examine properly a prisoner's welfare needs. For instance, Wandsworth, in so many ways an exemplary prison, has the continual challenge of coping with prisoners arriving from the south-west London courts. As the annual report of the Chief Inspector of Prisons for 2002–03 put it succinctly,
"population pressure means that prisoners are decanted rapidly to whatever places there are in the system".
Let us not forget that it is the new arrivals who are at the most risk of suicide. Your Lordships will be aware from previous speeches that 40 per cent of all suicides occur within the first month of custody and 10 per cent in the first 24 hours. Several speakers have drawn attention to the insidious effect of boredom on the morale of vulnerable prisoners and the need for a meaningful degree of purposeful activity, which embraces among other things time spent at work and in education and training, physical education and offending behaviour programmes. The minimum target is measured by the key performance indicator, which requires that every prisoner should spend on average 24 hours a week on purposeful activity. The KPI has been met only once in the past eight years. My noble friend Lord Elton produced a list of a wide range of activities that might be possible—and I certainly endorse his plea for a greater involvement from the private sector.
It is a statement of the obvious that one way in which to reduce overcrowding is to reduce the prison population. I note that the Carter report published in 2003 envisages that the number of prison cells required by 2009 can be cut by 13,000 by the greater use of fines. That relies heavily on the Sentencing Guidelines Council implementing a change in sentencing practice and helping to "align"—as it says—capacity with the demand placed on the system by sentences. I am told by my noble friend Lady Noakes that before I arrived the noble Lord, Lord Dholakia, made that point. If that policy is successful, its effect will be felt first by a fall in the number of remand prisoners—although many of your Lordships may be forgiven for thinking, "I'll believe that one when I see it". Can the Minister give the House reassurance that that policy is on course?
On the subject of remand, I remind your Lordships of two statistics highlighted by the noble Lord, Lord Corbett—that more than half of all those who kill themselves in prison are on remand and that 60 per cent of those remanded to custody do not subsequently receive a prison sentence. I feel that those two statistics, taken together, provide a really damning reproach on our society.
I am aware of the initiatives being taken by the Government to address the monitoring of prisoners at risk by the replacement of the existing self-harm and monitoring process known as F2052SH to the new Assessment Care in Custody and Teamwork Plan, a point made by my noble friend Lord Elton. I shall be very interested to hear from the Minister how this transition is working out.
The points concerning children in custody in prisons have been so well made by so many of your Lordships today that I feel there is little to add.
The noble Lord, Lord Hooson, made a suggestion for a royal commission. This I would very much support. I hope that this royal commission will address at an early stage the embarrassing fact that our prison population is 141 per 100,000 of the population. In Germany the figure is 98 and in France 93. That must have a bearing on the subjects we have been discussing today.
In a previous debate on this subject the noble Lord, Lord Judd, made a remark which left an impact on me. He reminded the House that when a person goes to prison the state takes total, but total, responsibility for that person—for his or her welfare and rehabilitation. It is a point that was brought out again by the right reverend Prelate the Bishop of Worcester. He said that although capital punishment has been abolished in this country—whether it is the wish of the people or the wish of Parliament, it has been abolished—we have a form of capital execution which we are not able to overcome at this point.
The noble Lord, Lord Dholakia, has done the House a service in drawing attention to the problem of overcrowding and the sad link with suicide—areas in which, quite frankly, the state is failing in its responsibility. I know that the Minister has been given advance dispensation by the noble Lord, Lord Giddens, but I also know that we shall not be disappointed. I very much look forward to her reply.
My Lords, I thank the noble Viscount and all those who have welcomed my return. Whether that welcome will remain after I have spoken I do not know, but we will wait and see. I join noble Lords who have very genuinely and warmly thanked the noble Lord, Lord Dholakia, for initiating this very important debate—a debate which has been of extremely high quality. Each and every noble Lord who has spoken in the debate has shown their commitment and passion to those who have been so unfortunate as to find themselves in such difficulties that they end up in our prison estate.
There are a number of issues on which we all agree. I hope that I will be able to answer many of the questions that have been raised. I assure the noble Viscount, Lord Bridgeman, that if I do not give him a specific answer to some of the issues he raises I shall indeed write to him, as I intend to write on the two specific questions asked by the noble Lord, Lord Dholakia, about the Government's response to the reports.
In the face of the rising population levels, suicide prevention efforts are proceeding with unprecedented energy and commitment, and with some success. This year, despite the rise in population, self-inflicted deaths are 25 per cent down compared with 2004; there were 64, three of which were women, against 85 which included 13 women. That does not mean that we are in any way complacent. We simply acknowledge that that is the position. Last year's overall rate of 113.7 self inflicted deaths per 100,000 average prison population only narrowly missed the challenging target rate set at 112.8 set alongside the Government's target for reducing suicides in the community.
I am aware that such annual numbers and rates can be volatile. I think that that was made clear in the comments made by my noble friends Lord Rosser and Lord Giddens, though for different reasons. It may be that the three-year rate is a much more reliable indicator of underlying trend, but that also has been falling over the past year. At the end of September, it stood at 124.1 self-inflicted deaths per 100,000 of prison population compared with a peak of 135.6 for the three years ending September 2004.
In this debate there were a number of issues that seemed to attract little dispute and on which we all agree. Perhaps I may outline what they appear to be. First, we all wish to see a reduction in the number of suicides in prison. I view that as one of my top priorities. The rate of self-inflicted deaths in prison is far higher than the rate in the community, although not of people under supervision in the community. Each death carries with it untold heartbreak for the individual's family and friends as well as for prison staff and other prisoners. However, my noble friend Lord Giddens is absolutely right when he points to the fact that the research which we have at the moment does not compare like with like. Therefore we have to be appropriately cautious in dealing with those statistics.
Secondly, the prison population contains a very high proportion of highly vulnerable individuals with family, relationship, educational, housing and employment difficulties, not to mention the obvious stresses associated with being in custody. Many are struggling to cope with additional various combinations of problems that further increase the likelihood of their self-harming. A number of noble Lords have mentioned the factors that put them at risk whether in prison or not and continue to increase the likelihood of their harming themselves upon release.
We accept that many of the problems with which prisoners are faced are those which have not been adequately addressed while they were in the community. The need aggressively to attack those causes of crime remain. Many young people who end up in our secure estate are, as the noble Earl, Lord Listowel, made clear, some of our most difficult to deal with, and it is often they who end up in our adult estate.
Office for National Statistics research in 1998 gave some interesting pointers of that, some of which have already been referred to. Previous self harm and suicide attempts: 44 per cent of women compared with 27 per cent of men on remand had attempted suicide in their lifetimes. Previous abuse: 22 per cent of male remand prisoners who had attempted suicide in the past year had suffered sexual abuse in the past. Drug problems: 55 per cent of those received into prison were problematic drug users, with 80 per cent reporting some history of misuse. Alcohol problems: 63 per cent of sentenced males and 39 per cent of sentenced females were classed as hazardous drinkers in the year before coming into prison. Mental health: 76 per cent of female remands and 50 per cent of male remands were found to suffer from a common mental illness such as depression or anxiety, which were mentioned by the noble Baroness, Lady Murphy, and others. Some 95.5 per cent of prisoners who had had suicidal thoughts in the previous week were found to have a common mental illness, and 15 per cent of female prisoners and 11 per cent of male prisoners were found to suffer from psychosis.
One of the other factors that worry me is the impact of domestic violence on those figures. As noble Lords will know, I am the Minister responsible for our domestic violence policy. Some 46 per cent of the female offenders under supervision have been identified as suffering from a history of domestic violence. So all the trenchant efforts that we have made in reducing domestic violence in the community will and should have a dramatic effect on the numbers of women and men and children who are subjected to domestic violence and then find themselves no longer victims but perpetrators of other offences in the community. I was delighted this week to announce the launch of the 25 specialist courts for domestic violence and, today, an additional £1 million to enable us to take that programme even further so that we have specialised courts across the country. We have already found that addressing those issues means that people get the domestic violence issue dealt with more effectively. If we do that, we might drive down some of these numbers.
The things we are doing in prisons are not the only things we need to look at. We need to look at all the issues across the piece: what we are doing for Sure Start, Connexions, education, after school clubs, which were mentioned by the noble Lord, Lord Elton; what we are doing to drive down domestic violence, to rehouse people, to educate them better and to get them jobs. All of that is significant in our work. As my noble friend Lord Giddens said, we bear in mind that the statistics that we have, and the proper interpretation that we put upon them, has to be approached with a deal of caution.
Thirdly, the current high population levels are a concern. That theme ran through every speech. The number of people in prison in England and Wales reached a new all time high of 77,758 on
This is not a straightforward matter. Overcrowding alone does not explain why there are self-inflicted deaths in prisons. I have mentioned the known risk factors that offenders bring with them into prison. Morven Leese of the Institute of Psychiatry has conducted research looking at the relative importance of different establishment factors, including overcrowding, in predicting rates of self-inflicted death across the estate. Dr Leese has found that higher self-inflicted death rates were associated with particularly high levels of overcrowding in individual prisons, as were high rates of positive drug tests and lower levels of purposeful activity and completed offender behaviour programmes. We take all of that into account.
Another piece of evidence is that prisons with the highest rates of "churn" or turnover tend to have the highest rates of self-inflicted deaths—an issue mentioned by the noble Viscount, Lord Bridgeman. But these prisons also tend to be locals, which have the largest proportions of prisoners displaying key risk factors. Coming back to the remarks of my noble friend Lord Giddens on caution, what can we make of that?
My noble friend Lord Giddens rightly pointed out that cell sharing is a known protective factor against suicide. A number of noble Lords mentioned that. Although I should make it clear that I am not promoting two or three prisoners sharing cells that were certified for one, not all cell sharing is disadvantageous. That is all I intend to say on that point. It just shows how complex the matter is. The doubling-up of an at-risk prisoner with a cellmate can help to reduce feelings of loneliness and provide both with someone to talk to. Cellmates can also inform staff if they are particularly worried about their companion, although, of course, it remains the ultimate responsibility of staff to deal with those matters. I reassure the right reverend Prelates the Bishop of Worcester and the Bishop of Leicester and my noble friend Lord Giddens that we absolutely accept the importance of the role played by chaplaincy teams for staff and prisoners. We agree with what was said by the right reverend Prelates in that regard. The National Offender Management Service actively seeks the involvement of chaplaincy teams in the development of, and training programmes for, the new family liaison officers being introduced in prisons together with—as many noble Lords will know—the development of community chaplaincies so there is a follow-on after the person leaves prison.
As has been said, vulnerability can be both imported from the outside world when a prisoner enters custody or it can be a product of the experience of imprisonment. While we may have little control over the former, although we can do our best to help prisoners with the issues with which they arrive in custody, we are working hard to combat the latter and to ensure, as far as is possible, that the experience of imprisonment does not become a trigger factor for vulnerability. This includes the broad, integrated and evidence based prisoner suicide prevention strategy that we have in place, reducing distress for all prisoners, not only those identified as being at risk of suicide or self-harm, embedding suicide prevention as a current through every area of prison life, including detoxification, decency, healthcare, purposeful activity, staff training and the built environment. Every prisoner benefits and fewer are likely to turn to harming and killing themselves if we can change the general ethos.
I am pleased to say a little more about assessment, care in custody and teamwork as I was invited to do by the noble Lord, Lord Elton, and, I hope, reassure the noble Baroness, Lady Linklater, that work on this has been undertaken aggressively. The prisoner suicide prevention strategy seeks to provide the best possible care to those who we know to be at particular risk of suicide and self-harm. The key intervention currently being introduced across public and private prisons alike is the new care planning system for at risk prisoners, ACCT. ACCT aims to improve the quality of care by introducing flexible care planning that is prisoner centred, supported by improved staff training in assessing and understanding at-risk prisoners. ACCT bridges the crucial interrelationship between suicide prevention and mental healthcare provision; for example, by linking with reception screening, mental health awareness training and mental health in-reach, which was mentioned by the noble Baroness, Lady Murphy, and was asked about by the noble Earl, Lord Listowel. Significantly, the implementation is taking place in close partnership with regional NIMHE (National Institute for Mental Health in England).
I am confident that ACCT will have a positive impact on the care provided to vulnerable at-risk individuals. The reason we have given a time frame is that the training involved is very important. We need properly to train all the people who are going to operate it. The multi-disciplinary way in which it is being operated is an advantage, and it is successful. However, I would hate the noble Baroness to think that it is not being pushed as hard and as fast as we possibly can. We understand its importance. Already there are early signs of improvements in prisons that are early implementers of ACCT. Since April 2005 there has been a 5 per cent drop in the rolling three year numbers of annual self-inflicted deaths in the 30 establishments now using the new system, with the five ACCT pilots seeing a 10 per cent drop since starting in January 2004.
While ACCT is a great example of joint prisons/NHS working, the new primary care trusts/prison partnerships have not been in effect long enough for us to have any more than anecdotal evidence that they are really making a wider difference. I thank the noble Baroness, Lady Murphy, and the noble Earl, Lord Listowel, for enumerating the things that we are doing in that regard and for the praise that they rightly gave to all those practitioners who are trying to implement this. The noble Baroness, Lady Murphy, asked whether this was a question of bureaucracy or numbers. We are doing something very new. It will take time. I personally celebrate the fact that it is at last being done and that we can monitor it, evaluate it and make sure that it is implemented across the piece. We are already seeing significant improvements. To make significant improvements to the mental health services available within prisons through the development of new, NHS mental health in-reach services backed by significant new investment, in-reach teams are now operating at 102 establishments and should become available by April 2006 within all prison establishments where the need for them has been identified.
Mental health awareness training for prison officers is being implemented as a long-term strategy to raise the effectiveness of discipline of staff in understanding, engaging and giving support in the care and management of prisoners with mental problems, and to ensure that prisoners assessed as too ill to remain in prison can be transferred to a hospital setting under the Mental Health Act. Our aspiration is for each individual who should be properly placed in the NHS rather than the prison estate to be so placed. That aspiration is absolutely shared by the NHS.
The noble Lord, Lord Ramsbotham, in effect asked about learning the lessons from history. I reassure him that we are doing so. Learning lessons and preventing reoccurrence of mistakes is developing into a key part of the ongoing strategy, as reports of the independent investigations into death in custody by the prison and probation ombudsman come on stream. Improving links with the IPCC and other sectors—the sharing of lessons learnt and experience—will help to reduce deaths. I assure the House that moving people only when it is absolutely necessary is very much part of the lessons that we are learning. The National Offender Management Service is not a matter of privatisation, contrary to the concern of the noble Lord, Lord Ramsbotham. It is not the abolition of the public service. We need the public service to continue, but we need the burden to be shared more broadly with others able to share it.
The noble Lord, Lord Elton, the noble Baroness, Lady Finlay, and others raised issues in relation to juveniles. Reflecting their needs and vulnerabilities, the general prisoner suicide prevention strategy contains a specific strategy for juvenile prisoners. That focuses on increasing activity within regimes, improved first night/reception facilities, child protection training, improvement of healthcare centres and mental health provision, support groups for those who self-harm, and promotion of peer support for juveniles through insider schemes. Noble Lords will know the good work done by listeners and others, and the use of personal officers.
Overcrowding and the consequent need to move prisoners around, sometimes at short notice, inevitably has its effects on prisoners' sense of well-being, but we are doing much to mitigate its worst effects. The visits that I have made to prison establishments have reinforced my belief in the dedication and professionalism shown by prison staff on a day-to-day basis in caring for a very vulnerable group of individuals. I add my voice to those who commend them for that work. A testament to it is the number of prisoners' lives saved by prison staff. Approximately 1,500 prisoners thought to be at particular risk of harming themselves are successfully kept safe in any given month, while almost 150 prisoners were resuscitated last year alone. I have also seen for myself prisoners' lives turned around.
There is a huge amount to do but I am confident that, through joint working, we shall make it a success. I hear what the noble Lord, Lord Hooson, says about a royal commission; all that I can do is reassure him that the work that we are doing now looks very like a commission's work.
My Lords, I am afraid that the noble and learned Lord is speaking out of order. We have to hear very briefly from the noble Lord, Lord Dholakia, so that the next debate can take place.
My Lords, I take this opportunity to thank all noble Lords who have contributed to the debate. They have vast experience, which is reflected in their contributions. I also thank the Minister for her response. It is perfectly obvious from the debate that many of us have differing views on this complex matter, but I start from the point that even a single death is unacceptable—it is one too many. Let us hope that today's debate gives us the renewed urgency mentioned by the right reverend Prelate the Bishop of Worcester, so that we can tackle this complex issue with policies that will at least help us in terms of alleviating and, to an extent, eliminating deaths when people are in the state's custody. In the mean time, I beg leave to withdraw the Motion for Papers.