Suicide and Self-harm in Prison (England)

Debate between Dan Poulter and Luciana Berger

Wednesday 1st March 2017 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I beg to move,

That this House has considered rates of suicide and self-harm in prisons in England.

It is a privilege to serve under your chairmanship this morning, Mr Chope. I am pleased to have the opportunity to discuss the record levels of suicide and self-harm in our prisons in this timely debate.

Yesterday, it was announced that prison officers planned to strike today. The reasons they cited were:

“More and more members…being assaulted every day”

and

“the increase in self-inflicted deaths and daily security breaches…as a result of staff shortfalls and budget cuts.”

The industrial action has been blocked by the Secretary of State for Justice, who won an injunction in the High Court, but the serious concerns raised by the Prison Officers Association cannot be ignored. Yesterday, a report from the Institute for Government declared that spending decisions have pushed prisons “beyond breaking point”.

Our criminal justice system rests on the idea that a person who has committed a crime should be punished if necessary and, as a last resort, by the removal of their liberty. By removing a criminal’s freedom, we seek to protect the public from the criminal’s activities for the duration of their time in prison. We also aspire to provide meaningful opportunities for rehabilitation so that on release, the prisoner can rejoin society as a law-abiding citizen.

What we do not do in the United Kingdom, and have not done since 1964, is use the removal of a criminal’s life as a punishment, yet within our modern-day prison system an all-time record number of prisoners are paying for their crimes with their lives. Official data published by the Ministry of Justice on 26 January showed that 119 prisoners died by suicide during 2016—the highest number in a calendar year since current recording practices began in 1978.

Inquest, a charity that monitors deaths in prisons, has reported that already there have been eight recorded self-inflicted deaths in 2017, with a further seven deaths awaiting classification. On average, a prisoner dies by suicide every three days, and 12 women lost their lives through suicide in 2016. The Minister might be tempted to say that the increase in deaths by suicide is a reflection of the increase in the prison population as a whole, but that argument does not stack up when we look at the figures. The number of deaths by suicide has doubled in just five years, yet the size of the prison population, currently standing at a little over 85,000, has plainly not doubled since 2010.

The Minister might be further tempted to suggest that a prisoner who takes their own life in prison might have done the same on the outside, but a self-inflicted death is 8.6 times more likely in prison than in the general population, according to the Howard League for Penal Reform.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Lady on securing this important debate. She has made some excellent points, to which I hope to hear the reply later. Does she agree that a suicide in a hospital would be a very serious issue and that a suicide in prison should be taken no less seriously? Urgent action is needed to reduce suicides that take place on prison premises.

[Luciana Berger]

I thank the hon. Gentleman for his intervention and for his commitment to the issue of mental health. Deaths in prison should be treated no differently from those in any other setting. Issues such as ligature points are contended with very differently in inpatient settings and in prisons. We could point to many things that should be treated in the same way as in any other element of life outside prison.

The number of self-harm incidents has also reached a record high of 37,784, which is up nearly 7,000 on the previous year.

One group that has been uniquely failed by the prison system is transgendered prisoners. There have been four deaths by suicide of transgendered people while in prison over a mere matter of months. That is from an estimated prison population of just 85.

We know that the prevalence of mental health conditions is much higher among the prison population. Prisoners are over three times more likely to suffer from depression, 12 times more likely to suffer from a personality disorder and 16 times more likely to suffer from psychosis.

For prisoners who need to be treated in a mental health inpatient unit, departmental guidance states that transfers under the Mental Health Act 1983 should take place within 14 days. I was appalled to learn from the answer to my written parliamentary question that in 2015-16, 1,141 prisoners—three in four—waited longer than that two-week window. Such ubiquitous failure would never be tolerated in the outside world.

With regard to data on mental health in prisons, it feels like a minefield trying to get hold of figures that give a true representation of the scale of the problems. I cannot help but feel that the Minister and his Department are trying to pull the wool over our eyes. When I resubmitted my question to get the most up-to-date figures, I was told that, in the space of just a few months, the data are now

“not held in the requested format”,

despite the wording of my question being identical. I hope the Minister will tell me why the collection of the data has changed.

When I finished drafting my speech shortly before we began this morning, the Department’s answers to four of my named-day questions were long overdue. The answers would have played a key part in my contribution, but, regretfully, I cannot hold the Government to account fully for them today. Just one example is a question I asked about what proportion of people who died by suicide in prisons were not on the assessment, care in custody and teamwork pathway for people who have been identified as being at risk. In 2015, only 35 of 89 people who died by suicide were on the ACCT pathway, suggesting that too many vulnerable inmates are not being identified early enough. I asked the question again on 31 January—over a month ago—and the Minister’s Department has still not come back to me with that vital information.

Prison should offer a unique opportunity to provide mental health treatment in a secure environment, but the Government are betraying the vulnerable people our criminal justice system is supposed to protect. I met representatives of the Prison Officers Association who told me that, despite having worked in the Prison Service for decades, they had never received any mental health training. A recent Royal College of Psychiatrists forensic faculty survey found that service cuts mean most prison psychiatrists do not feel able to deliver a basic level of care. It is clear that the mental health services in our prisons are buckling. On a recent visit to a local prison, I saw at first hand the lack of care and services available to inmates. A recent consultation by the Centre for Mental Health found that a decrease in prison staff meant inmates often missed psychiatric appointments because there was no one available to escort them, and consequently they could not get the treatment they needed.

This is the stark reality that has been created by decimating staffing levels in prisons. There are 7,000 fewer prison officers than when the coalition Government came to power in 2010. The impacts of such drastic cuts are not trivial. Our prison services are out of control. Assaults in prisons rose by a third in the 12 months to September 2016 and are the highest on record. There was a wave of prison riots in the final weeks of last year, including at Birmingham, Bedford, Swaleside and Lewes. The inconvenient truth for the Minister is that, as things stand, he cannot guarantee the security of anyone who sets foot in our prisons.

Her Majesty’s inspectorate of prisons has found that an increasing number of prisoners report feeling unsafe in prison. Yesterday, we heard the conclusions drawn from an unannounced inspection of HMP Featherstone. We heard that some prisoners felt so unsafe in the prison that they resorted to self-isolation, asking to be locked up for nearly 24 hours a day. In some instances, this had lasted for months.

Nationally, there has been a significant increase in the ratio of prisoners to prison staff. It is not only prisoners who do not feel safe, but hard-working staff who brave the frontline every day, aware that there might simply not be anyone there to back them up if an incident becomes unmanageable.

A couple of weeks ago, BBC’s “Panorama” aired an undercover investigation that was filmed inside HMP Northumberland. I am sure anyone who watched it was, like me, appalled to see the truth about prison life laid bare: pervasive violence; widespread drug use; security systems not fit for purpose—put simply, chaos.

During this debate, it is important to remember that part of the reason this dire situation has arisen is that far too many people have been inappropriately put in prison, when they should be receiving mental health treatment in a secure inpatient unit. There is a need to address how the courts treat people with mental health problems, particularly in respect of community sentences and the inclusion of mental health treatment requirements within those.

I have been raising questions about suicide and self-harm in our prisons for many years, but I was compelled to request this debate because of one particular case, the tragic case of Dean Saunders. He was just 25 years old when he died by his own hand at Chelmsford prison in Essex last year. I had the privilege of meeting Dean’s parents, Mark and Donna, to hear about this tragic case in their own words. Dean was suffering from severe mental illness and had harmed himself and his brother and father as they tried to help him during a paranoid episode. He was charged with attempted murder and sent to prison. His family were told that there he would be safe.

The inquest jury unanimously concluded that Care UK, the private company that ran healthcare at the prison, treated “financial considerations” as a significant reason behind the decision to downgrade him from constant watch to half-hourly observations, despite several warnings that he might harm himself. It said that there were “multiple failings”, including a “complacent” approach to Dean’s mental health. The jury found an assessment of his mental health needs was “not adequately conducted” and concluded that the cause of death was “contributed to by neglect”.

The system failed because of financial cuts in the prison budget, and Mr Saunders paid for it with his life. Despite that damning verdict, Care UK continues to provide healthcare, including mental health services, to more than 22,000 prisoners in many prisons across the UK.

I note that the Justice Secretary has met Mr Saunders’ family, and I welcome that, but Mr Saunders presented a high risk of suicide—he should never have been in a prison in the first place. He needed specialist treatment in a secure mental health facility to protect him, but none was made available.

[Dr Poulter]

Does the hon. Lady agree that one of the problems may well be that people are siloed into being under either the care of forensic psychiatry or that of the prison system? There is very little and very poor interaction between the general mental health system and what goes on in prison, particularly in terms of helping people to receive the adequate care in the community that they need when they leave prison on discharge.

[Luciana Berger]

There have been many reports, inquiries and recommendations that highlight the very point the hon. Gentleman made—reports dating back to 10 years ago. I hope the Minister will reflect in his response on the reports, inquiries and recommendations that have already been put forward and outline what he will do to ensure that that current separation is adequately addressed to prevent situations like this case. What are Ministers going to do to ensure that similar situations to what happened to Dean never happen again?

The shocking and shameful rise in suicide and self-harm is happening on this Government’s watch and the Minister must outline his plan of action today. These are not statistics; they are real human beings—somebody’s father, somebody’s mother, somebody’s daughter or somebody’s son. The Government cannot get away with sweeping this issue under the carpet for a second longer. I note that the Joint Committee on Human Rights is also conducting an inquiry on this issue and I hope that today’s debate might be a precursor to the outcomes of that inquiry.

Last month, in Justice questions, I raised Mr Saunders’ case. The Under-Secretary of State for Justice, the hon. Member for Bracknell (Dr Lee) told me that he was

“seeking the details of all those cases to see whether there is a pattern in why they are happening. I hope to come forward later in the year with suggestions for policy change relating to mental health assessments in prisons.”—[Official Report, 24 January 2017; Vol. 620, c. 156.]

An assessment is not, in and of itself, enough. However, when I sought more details in a written parliamentary question, the Secretary of State’s answer exposed a U-turn on any plans for such an investigation. Although another exploration of data would have been wholly inadequate, it would at least have been something. Now it seems that the Government have no plans in place to confront this crisis.

If the Minister thinks that a further review of the evidence is needed, I am here to disabuse him. If he thinks we need more consultation, I am afraid he is mistaken. Countless inquiries and reports have been conducted, which have a plethora of very practical recommendations to their name. There was the review carried out by Baroness Corston on women and, significantly, the Harris review on self-inflicted deaths of young people, which was the most comprehensive review of suicide in prison and heard directly from bereaved families. Many important recommendations on learning and accountability were put forward, which so far have been rejected.

Families tell us time and again that what they want after a tragedy like this is for no one else to go through a similar experience and for concrete changes to be made. Ultimately, we are seeing the same failings repeated time and again in this pattern of preventable deaths. There is currently a significant accountability gap. Deeds, not words, are what are needed now; a concrete plan of action is necessary, not yet another ministerial speech. I say that in memory of all those who have died by suicide in our prisons. It is unacceptable. We abolished the death penalty half a century ago for very good reason. Now we must ensure that in 2017, no prisoner pays the penalty of their life because of the failure in our prison system. I look forward to the Minister’s response.

NHS (Government Spending)

Debate between Dan Poulter and Luciana Berger

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?

[Dr Poulter]

Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.

We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.

At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.

The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

Oral Answers to Questions

Debate between Dan Poulter and Luciana Berger

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

As my right hon. Friend will be aware, the funding formula is now reviewed regularly. That is done independently and is free from political interference. Looking at areas such as hers, where there are a lot of frail and elderly patients, is now more paramount in the funding formula. In the future, I am sure that the funding formula will better reflect local health care needs.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

One in four patients now wait a week or longer to see a GP. Last week’s official NHS survey revealed that almost 1 million people had to turn to A and E because they could not get a GP appointment. Will the Minister accept that his Government have made it harder to see a GP, and have caused the A and E crisis in the process? Will he respond to Labour’s call for GPs to be placed in major A and Es to help ease the pressure?

[Dr Poulter]

I do not think that people wanting to see their GP was at all helped by the previous Labour Government’s disastrous decision to contract out the GP out-of-hours service. Many patients are now struggling to receive appointments in the evenings and at weekends. The previous Government also broke the link with family doctors. To reassure the hon. Lady, the latest GP patient survey results suggest that less than 2% of patients who want GP appointments have to resort to walk-in centres or A and E departments. Under this Government, we have put in place an extra 1,000 GPs.

Oral Answers to Questions

Debate between Dan Poulter and Luciana Berger

Tuesday 11th June 2013 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

5. What estimate he has made of the optimal level of bed occupancy in NHS hospitals.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Average annual bed occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000. The Government do not set optimal bed occupancy rates for the NHS. NHS hospitals need to manage their beds effectively in order to cope with peaks in both routine and emergency clinical demand.

[Luciana Berger]

I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined. What urgent action are the Government taking to reduce bed occupancy levels and prevent next winter being even worse?

[Dr Poulter]

We had this debate last week. The long-term pressures on the NHS, as we know, are the result of an aging population, with increasing numbers of older people arriving in A and E with complex needs, so the challenge is to ensure that they are better treated in the community. That is why my hon. Friend the Minister of State launched the integrated care pilots last month. We are also seeing more patients treated as day cases than ever before. About 80% of elective admissions are now treated as day cases, which shows a massive improvement in the speed and quality of care in the NHS.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We will certainly look into the issue that my hon. Friend raises, but he will be aware that there are campaigns throughout the NHS focused on supporting local food producers, which is important in many constituencies, particularly rural ones, and developing best practice and encouraging nutrition. Chefs such as James Martin have been involved in helping to drive up standards of care, particularly in Yorkshire and other parts of the country.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

Oral Answers to Questions

Debate between Dan Poulter and Luciana Berger

Tuesday 27th November 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.

[Luciana Berger]

I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?

[Dr Poulter]

It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.