Again, I want to highlight an issuethat the Government need to demonstrate increasing awareness of, namely, health provision for the mentally   ill inside prison. I started the debate last week, but the matter is perhaps more appropriately dealt with under Clause 20.

Under clause 20(1), the Prison Act 1952 is amended where section 7(1) makes appointing a medical officer for each prison a requirement. That provision will now be omitted. I can understand the policy, because now health services are provided within prison by the national health service through the local primary care trust. Patients in prison are on the list of a local GP practice, or covered by some other arrangement made by the PCT, so a dedicated prison doctor is no longer necessary. However, if we are not to have a dedicated prison doctor, we must surely have proper facilities for the treatment of the mentally ill.

The problem cannot be just brushed under the carpet. Lord Phillips, the Lord Chief Justice, speaking to the all-party parliamentary group on substance abuse in March 2006 in this building, said:

“Many actual or potential criminals are dangerous because they suffer from personality disorders or other mental conditions which can be diagnosed as illnesses. Prison is not the best place to detain those who are mentally disordered.”

Sadly, however, all sorts of people with mental disorders are sent to prison, partly because the national health service no longer has provision for residential care of the mentally ill, which, in fairness, partly flows from the failure of the care in the community systemto cope with many of the people who have mental illnesses. A number of people who live rough or commit crimes of violence are mentally ill. They may be mentally ill because they have a mental problem that has occurred naturally, or the balance of their mind has been affected by drugs. It does not matter why they are ill, however; what is important is that once diagnosed, they receive the appropriate treatment. It is regrettable that prisons are used—I say this not only as a politician but as a Crown court recorder—as adjuncts to the national health service.

Mental health problems are worryingly prevalent among those entering prison: 72 per cent. of males and 74 per cent. of females in prison suffer from two or more mental disorders, compared to only 5 per cent and 2 per cent. respectively of the general population. What is more, 20 per cent. of men and almost 40 per cent. of women entering custody say that they have attempted suicide. In the past decade, one prisoner has committed suicide every four days.

There is no point in saying that mentally ill offenders would be better managed outside prison and would be better off if they never entered prison in the first place. That is uncontroversial and has been stated by Anne Owers, the chief inspector of prisons. Her estimate, based on visits to prisons, is that 41 per cent. of prisoners held in health care centres should be in secure national health service accommodation. The Lord Chief Justice agrees. In relation to prisoners suffering from mental disorders, he says that

“many of these would be better detained in mental hospitals.”

Treatment of the mentally ill in prisons is far from ideal. I appreciate that the ordinary prison officers who do the health work in prisons do their best, but they are not trained to deal with mentally ill people. As a result of overcrowding in prisons and the insufficient number of prison officers looking after prisoners, particularly at weekends, the mentally ill are left in their cells instead of being given appropriate treatment.

There are mental health in-reach teams in 102 prisons, but at any one time there are likely to be at least 40 prisoners who, having already been assessed, must wait three months or longer before being transferred to hospital. Many more have a long wait before an assessment takes place.

Far from helping to cure mental health problems, the environment and the regime of prison seem likely to exacerbate them. Research has shown that 28 per cent. of male sentenced prisoners with evidence of psychosis reported spending 23 hours or longer in their cells each day—more than twice the proportion of those without mental health problems who spend that length of time in their cells. Suicide attempts and incidents of self-harm are frighteningly high. Nearly a third of women in prison injure themselves an average of five times, and 6 per cent. of men do so twice.

Jonathan Aitken, who involuntarily became something of an expert on prisons, has written this about his time in prison:

“On the wing, there was plenty of evidence of behaviour brought on by mental distress...one young man only ever wore the same pair of jeans and a green nylon cagoule. He never wore shoes or socks, never went out on exercise, hardly ever spoke to anyone and was understood to have been taken advantage of sexually by predatory prisoners...Another had a habit of inserting objects into his body: a pencil in an arm, matchsticks in his ankle.”

The conclusion that he drew, and that I draw, is that prison does little to address the many and severe mental health problems of its inmates. That has consequences for the resettlement needs of released prisoners with mental health problems, because those needs are not being identified or met. Some 96 per cent. of mentally disordered prisoners, including 80 per cent. of those who have committed the most serious offences, are put back into the community without supported housing. More than three quarters are given no appointment with outside mental health experts or carers. According to the Government’s social exclusion unit, more than 50 prisoners every year commit suicide shortly after release.

Hidden behind the apparently uncontroversial clause is an enormous problem that is getting worse and needs to be tackled. If the Government are not to have a dedicated medical health officer in every prison because of the new arrangements with PCTs, it is incumbent upon them to ensure that there is, not merely some mental illness care, but more than adequate mental illness care for people going into prison, those in prison and those coming out of prison. I do not attach personal blame to the Minister, but the Government can no longer say, “Well, this is something we have inherited.” They have been in office for 10 years. I look forward to some words of reassurance from the Minister.

Clause 20(3) makes ineffective section 17 of the Prison Act 1952, which bans painful tests carried out by medical officers on prisoners in order to detect malingering or for other purposes. Why is a painful test for any purpose necessary? Will the Minister explain precisely what is the purpose of removing section 17, and therefore the ban on such tests, and say what will happen instead? I cannot believe that any humane medical officer would deliberately hurt anyone, although some investigations clearly require discomfort  to be inflicted on a patient. I look forward to hearing the Minister’s explanation of clause 20(3) and ofthe removal of obligations under section 28(5) of the 1952 Act.