Prisons: Young People

Lord Adebowale Excerpts

Thursday 29th October 2015 Lords Chamber

[Lord Adebowale (CB)]

My Lords, I thank the noble Lord, Lord Harris, for bringing this important debate to the Chamber. I declare my interest as chief executive of Turning Point, a health and social care charity and social enterprise which works with people with complex needs—including mental health, substance misuse and learning disabilities—many of whom are young people. In a sense, we are the ambulance at the bottom of the cliff which works with the results of failure, I guess.

I reiterate the call in the report of the noble Lord, Lord Harris, on deaths in custody of 18 to 24 year-olds that more needs to be done, in and out of prison, to ensure that the number of self-inflicted deaths is reduced. Indeed, I agree with all the remarks made by the noble Lord, Lord Dholakia, the noble and learned Lord, Lord Phillips of Worth Matravers, and the noble Baroness, Lady Healy of Primrose Hill. We need to start looking more carefully at this group of young people, and the requirements for sufficient numbers of appropriately trained staff in young offender institutions and prisons; a wider range of better-resourced residential placements outside the prison system for young adults in conflict with the law; adequate sharing of information across and within agencies; and mechanisms to monitor, audit and follow up recommendations from investigations and inquests.

It is important, as many Peers have mentioned, that one reads the stories of these young people to understand the impact of the failure to provide adequate services properly. One case study sticks in my mind after reading through the Inquest and T2A report Stolen Lives and Missed Opportunities. It is that of Alex, a 15 year-old mixed-race boy who was found hanging in his cell by his shoelaces in 2012 and, sadly, died while in custody. Alex was placed in long-term foster care at five years of age after being sexually abused by a member of his maternal family. He suffered trauma from the abuse later on and became difficult to manage due to his complex needs: ADHD, attachment issues and educational difficulties. He had a total of eight different social workers from the age of five until his death. In 2011, he received a 10-month custodial sentence. This was his first time in custody but, due to his age and vulnerabilities, he was sent to an institution where he was one of the youngest children.

On the day of Alex’s death, he was in a clearly heightened state of distress and had made a disclosure about his sexual abuse to a prison officer for the first time. It was found that adequate support was not given. The failures included: having no named social worker; a lack of communication with external agencies; no support for Alex’s specific mental health needs; not having an adequate level of support for him or other vulnerable looked- after children; and that youth offending workers did not have enough responsibility for Alex’s care needs while in custody—and before he arrived in custody, there was no evidence of an appropriate forensic psychiatric assessment. When you look at that case, you can see the litany of errors. There was no adequate psychiatric assessment when he could have been diverted from custody and subsequent fatal actions. This is clearly a tragedy and one which could have been avoided.

It is a welcome statistic to note that the number of young adults in custody is declining, but there are still too many with complex needs entering the prison system. We know that management of young adults requires a distinct approach. Those who remain in custody are some of the most vulnerable, troubled young adults with complex needs such as family discord, substance misuse, mental health difficulties and learning disabilities. They are often the victims of exploitation, abuse and trauma, underpinned by poverty and inequality. We need to change the cycle that exists between poverty, complex needs and prison so that the number of people entering the criminal justice system with complex needs is reduced. My view is that young people with the needs that Alex had and who end up in prison should be seen as a “never” event. It is a crisis, not something that we should accept as a given.

It is therefore clear that we need to intervene early, but there is a significant group of young people who we still too often ignore. The noble Baroness, Lady Healy of Primrose Hill, made this point about children in care but I wish to emphasise it. There are 69,540 children in care at any one time, with 6,000 leaving each year. We know where they are and when they leave. Statistics released by the Department for Education show that as of 31 March 2015, there were 260 looked-after children in England’s YOIs out of a custodial population of 706—a proportion of 36.8% were in care. As has been pointed out, less than 1% of all children in England are in care but, according to the Beyond Youth Custody report, looked-after children make up 33% of boys and 61% of girls in custody. These children are meant to be looked after by the state; that is evidence that it is just not happening. Prison is overused, due to the shortages in the health and care systems to address their complex needs. Young people need interventions, not incarceration.

Children in care are there because of abuse and neglect; that is not an excuse for their criminal behaviour but the pattern that leads to that behaviour is clearly established, well before they come to the attention of the criminal justice system. Such children are four times more likely than their peers to have mental health difficulties, less likely to do well at school than their peers and more likely to experience even more abuse and/or neglect when in care. There are clear patterns that health and social care professionals can work with.

It often strikes me as odd that we know where these children in care are. For example, in Stoke, I am told there are 500 kids in care at any one time. I do not think it is beyond the wit of woman or man to create a life care plan for each of these young people within the population of a county, town or borough such as Stoke. Such a care plan should start with understanding the dreams, desires and wants of that young person. They are not unlike my kids or kids that any of your Lordships might be privileged enough to have. What do they want to do? How do they want to do it? Using the private sector, public sector and voluntary sector resources in such a town, it should be possible to create a life care plan for each young person, which they are involved in and engaged in. It could be reviewed annually, or on a six-month basis, so that that individual gets attention and knows that they are surrounded by the kind of soft boundaries within which they can experiment, not unlike most middle-class children. That is surely possible, and if it were to happen, we would have fewer cases of children needing the criminal justice system in the first place. Where children have the complex needs that Alex had, they can be signposted and approached with the appropriate individual health and social care interventions. They are an ever smaller proportion of the 500 or so in a place such as Stoke.

Sweeping that to one side, let us look at the cost. Some 72% of children released from custody reoffend in one year, according to Barnardo’s. Doing nothing is not only immoral but expensive, as is carrying on what we are doing. If we know this, we need to do something about it and address the stock and flow problem that currently exists. It is surprising, and a bit sad, that the learning from the report of the noble Lord, Lord Harris, is similar to that from the report I did with the Independent Commission on Mental Health and Policing, which I chaired. The conclusions are similar, and frighteningly so: a lack of clear communication between agencies; a lack of adequate resources to staff these agencies; and those involved in criminal justice, health and social care not being fully trained to deal with complex needs. Indeed, the criminal justice system, just like the police system, is being used as a care resource rather than a resource of last resort. This is not the care that these young people should be getting. As I say, we need to change the cycle. The thinking that got us into this state cannot be the thinking that gets us out.

One way of doing this is through more community or residential-based institutions which work with children and young adults who are in the stock, as it were, of prison and young offender institutions, to progress them back into the community and keep them there. As I say, I think that is perfectly possible—I know the noble Viscount, Lord Younger, is going to shut me up in a moment, but I will continue for one more minute. It is possible to provide the care that these individuals need.

I close by reiterating my support for the noble Lord’s report. Prevention needs to be funded adequately and children in care need to be prioritised, because the maths is obvious. If we can deal with children in care, we can make inroads into this problem. On behalf of Alex and many others, there is no excuse. The report of the noble Lord, Lord Harris, is an excuse remover: we know where these kids are, we know where they come from, we know what the challenges are and we know we can put the services in to prevent them ending up like Alex. Let us just get on with it and do it.

Drugs and Crime

Lord Adebowale Excerpts

Tuesday 15th June 2010 Lords Chamber

[Lord Adebowale]

My Lords, after not speaking for some time in this House, I find myself on my feet twice in the same afternoon. It is a privilege to take part in this debate. I add my congratulations to the noble Baroness, Lady Meacher, on initiating it. This is a different debate from the usual one we have on substance misuse. It draws our attention to the discussion paper, which is a step forward—but only if we do more than just read it. We have to act on it, of course.

I declare two interests—first, as chief executive of Turning Point, which is probably one of the largest providers of substance misuse services outside the NHS, and as a member of the Government’s ACMD, the Advisory Council on the Misuse of Drugs.

Our current system is questionable; indeed, I think that it is broken. All the evidence points in the direction that substance misuse is best treated through health and social interventions. Substance misuse has roots in an individual’s psychosocial state. For treatment to be effective, the whole of the person needs to be the starting point of intervention. My organisation is incredibly ambitious for our substance misusers. It is a mistake to assume that providers of treatment for substance misusers allow them to languish on methadone without any intention of moving them towards work. That is wrong, certainly in the case of Turning Point and many of my fellow providers of treatment services, both within and outside the NHS.

We know the numbers, but it is worth repeating them. There are 400,000 problematic heroin and crack users in the UK, while 1.5 million people will be significantly affected by a family member’s drug use. I congratulate the noble and learned Baroness, Lady Butler-Sloss, on her remarks about children. About three years ago, Turning Point produced research showing that one in 11 children goes home to parents who are misusing alcohol. We must not forget the impact on children, as the problem is generational. We know that those children are more likely to fail in education and we know that failure to be educated thoroughly leads to low job attainment and a greater likelihood of ending up in the criminal justice system. The line that can be drawn between substance misuse, criminal justice, poverty and family breakdown is clear and well understood.

Recovery is dependent on the stability of the individual and is more likely if someone has a steady personal relationship, meaningful employment and stable housing. For me, the question has always been how to get people to the position of having the quality of life that makes recovery more likely.

The use of coercive techniques and prison to prevent substance misuse is questionable. When the noble Baroness, Lady Afshar, spoke about cannabis, we all laughed, but what she said was interesting. If you are caught with cannabis and happen to live in one of the 14 poorest boroughs, the chances of your ending up being able to give a speech in the House of Lords are severely limited, but if you are a member of the Royal Family or on the Front Bench of either party and you admit publicly that you have used cannabis, you will get off. It is an offence, but the impact is variable, depending on your status. That seems entirely unfair.

Leaving that to one side, I have yet to meet a substance misuser who has benefited from a spell in prison. Some might say it, but I have yet to meet anyone for whom prison as an intervention has been effective in removing their drug problem. Addiction is an irrational state. You can punish people until the cows come home, but you will not move them from their fundamentally irrational position. It does not work in that way.

Also, we are naive to think that prisons are drug free. They are not. As the noble Lord, Lord Thomas, said, prison imposes a stigma, but it also imposes a significant heroin problem. A number of clients whom I have known over the years have, immediately on moving out of prison, scored heroin and died, because their tolerance has been reduced by their spell in prison. They have been able to get hold of heroin in prison, but only in smaller amounts; when they come out of prison, they go back on to the dose that they were on before they went in and they die. In that respect, prison kills people.

The use of prison as a sanction for substance misuse is short-sighted and fails to acknowledge the nature of substance misuse. We should pay attention to the challenge not just of illegal drugs but of substance misuse generally. Many sufferers from substance misuse have dual diagnosis: they have mental health problems as well as substance misuse problems. It seems rather obvious that, if you decide to be in or are forced into a position where you are killing yourself through the misuse of any drug, you are probably challenged in terms of your mental health. The Royal College of Psychiatrists has suggested that approximately half of all clients in substance misuse services have some form of mental health condition, most commonly depression or a personality disorder. Prisons simply are not suitable places in which to manage personality or mental health disorders. Nevertheless, some people who misuse drugs will end up in prison because they commit heinous crimes. We must ensure that these people are given adequate support to address the root of their personal problems, and this means that health and social care interventions within prisons are a must.

My own organisation, Turning Point, was one of the first to pilot the drug courts programme in Wakefield. We campaigned for many years to get drug courts established because we saw the impact that they had on individuals and their ability to turn people away from substance misuse, and indeed the criminal justice system, towards work and a normal life.

The document that has been drawn to the attention of the House is not the only one that looks at drug treatment. My organisation has signed up to a drug treatment consensus, which has also been signed up to by many leading drug treatment providers. This consensus document encourages the coalition Government to remember that there is more to drug treatment than getting someone off drugs or stabilising them on methadone, which often ends up being the focus of the debate. Rather, we should consider the needs of the individual. Recovery from addiction is a journey on which there are different paths. However, when it comes to addressing their addiction, for some people it is better also to address what is influencing it in the first place. That is seen in the ambition of the signatories to the drug treatment consensus for those with substance misuse problems, although we acknowledge that methadone is a step on the journey towards recovery from heroin addiction.

Although it is an interesting issue, it is worth pointing out that I am not too concerned about having a debate on whether or not to legalise drugs. In a society with a system of legalised drug misuse, would we not have addicts? We would, and we would still be faced with the challenge of what to do with them. That is at the centre of this debate. However, let us move away from illegal substances and draw attention to the legal ones. Alcohol specialist treatment services are much needed.

Solutions to this problem do exist. Often they are denied not because of a lack of evidence—the evidence is there—but because of moral panic and a desire to play to the gallery. We have a once-in-a-lifetime opportunity to set aside moral relativity and to focus on the evidence and the interests of those who suffer from this terrible problem.