Mental Health

Lord Ramsbotham Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, like other noble Lords, I congratulate the noble Baroness, Lady Tyler, on obtaining this debate and for the way in which she introduced it. I also echo her tributes to the Ministers Paul Burstow and Norman Lamb for their work in the mental health post. I agree entirely with her call for a cross-government mental health and well-being strategy, which has been long needed.

When I saw the list of speakers, I knew that I did not need to say anything about learning difficulties and disabilities, as the noble Lord, Lord Addington, was there. Every time he stands up I realise that we are listening to someone who not only uses his experience wisely, but is worth listening to because of the practical things that he always adds. I also welcome the noble Lord, Lord Suri. I was very glad to hear him concentrate on elements of the criminal justice system, particularly Feltham. Not surprisingly, that is what I propose to do as well: concentrate on the criminal justice system.

Before I do, I declare two interests, first as vice-president of the Centre for Mental Health, which has done a great deal of work in the reissuing, in particular, of carefully researched reports, which have provided everyone with a great deal information on the whole system and the problems within it. Secondly, I am chairman of the Criminal Justice and Acquired Brain Injury Interest Group. This is doing a great deal of practical work, and showing up some of the shortcomings in the criminal justice system in identifying and assessing the problems that people have, and what needs to be done about them.

Echoing the noble Lord, Lord Goodlad, I should explain that I was fortunate enough before becoming Chief Inspector of Prisons to chair the hospital at Hillingdon, which had a very large and extremely well run mental health unit. The director said, “You must train as a lay assessor or otherwise you’re no use to this hospital”. I am extremely glad that he did because he gave me an insight on which I have based all my subsequent experiences.

When I took over as chief inspector in 1995, I was extremely alarmed to find that healthcare in prisons was not the responsibility of the National Health Service. It seemed utterly absurd because people came from the NHS and went to the NHS. The staff were not NHS-trained, and I discovered that only 10% of medical officers in prisons were qualified to act as GPs in the National Health Service. I set out to try to do something about it. That aim was achieved in 2003, eight years later. I was very glad that we had quicker-minded people acting for the country during the Second World War.

Fairly soon after that, in 1998, the Office for National Statistics published psychiatric morbidity figures for all our prisons. It produced the figure that the noble Lord, Lord Addington, cited: 70% of prisoners have one or more identifiable personality disorders. That does not mean that they are certifiable under the Mental Health Act, although at least 500 a year are, but it means that there is something wrong. If you can identify it and do something about it, that could mitigate the bad behaviour or whatever it was that led them to commit their crime. It has always seemed to me that the proper assessment of whatever mental health problems people come in with has been sadly missing. It has always been said that treatment in prisons should be the equivalent of treatment in the NHS, but unless the assessment is right, you will get no treatment that is worth the name. The importance of partnership in that is that time in prison is when various organisations could get to grips with whatever physical or mental health problems a person has and use the time to advantage. That must be a public health benefit when people are released.

An improvement that came from the Health and Social Care Act was placing commissioning for offender services under NHS England. Having heard about it, I looked forward to the development of local health and well-being boards on which I hoped the criminal justice system would be properly represented. However, I am concerned about the inconsistency of these boards, and it worries me that they meet only quarterly. If they are to help the criminal justice system in particular, meetings need to be more frequent and consistency between what happens in one health and well-being board area and another needs to be developed.

Having said that, like the noble Lord, Lord Goodlad, I welcome the foundation of the mental health and well-being task force. It is a healthy development in this area. I particularly welcome its children and young people sub-committee. The five all-party groups that are studying children and young people’s mental health and emotional well-being are going to meet the sub-committee. That is particularly relevant for one of my current concerns, which is that I do not think that all is well within the criminal justice system. I am currently very concerned that due attention is not being paid to the mental health needs of detained children. That is confirmed by the proposal to build a secure college for 320 of them under the age of 18 in which the emphasis is to be on education which, it is alleged, is the key to a reduction in reoffending. What is being proposed is totally at variance with the advice of those who have any experience of the characteristics, problems and needs of the children who will be sent there. The scant acceptance of this advice is reflected in the insistence by the Secretary of State for Justice that educational outcomes are more important than the selection of suitable staff. How wrong he is: staff are absolutely key to anything that is done.

I have two other concerns. One is purely to do with the criminal justice system and the other with the linkage between that system and people outside it with mental health problems. My first concern is probation. There are 200,000 people currently serving community orders. Only 20% of CCGs believe it is their area team’s role to commission healthcare for those on probation. We have just got that figure through the Freedom of Information Act. Only 1% of CCGs are currently directly funding general healthcare in probation; 40% have nothing to do with it; the remainder have some association with it. Only 6% of mental health trusts provide services for probation and the majority of that takes the form of a half-day advice clinic once a week. That is wholly inadequate and something must be done, somehow, to connect the Ministry of Justice and the Department of Health to improve support for those on probation, who have exactly the same characteristics as the Office for National Statistics showed in 1998 for those in prisons.

My second concern is employment, which is absolutely key to the rehabilitation of any offender but is also crucial to the future well-being of people with mental health problems. Last week, I attended the launch of a report by the Mental Illness and Employment Task and Finish Group, which addressed the serious inequality of employment outcomes for people with and without mental health problems. It is a very good report and Norman Lamb spoke extremely well at its launch. I welcome the recent introduction of CCG outcome indicators on employment rates for people with mental illness because this will, at least, draw the facts to people’s attention. I welcome the Commissioning for Quality Innovation targets for supporting adults who are in contact with mental health services. This is an unresearched area and we need to do much more if we are really going to provide mental health services in this country that are worth the name.