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Prisons: Suicides

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 20 October. Managing such numbers can lead to an increase in transfers between prisons—we have referred to that—itself a time of heightened risk. More people being received into custody means that some prisoners are located further from home, which in turn may mean that their access to familial or social support is affected. More prisoners being remanded to prison results in prisons processing large and variable numbers of prisoners, often arriving late in the day, which may reduce the time staff can spend with individual prisoners on care and risk assessment. Overcrowding can result in an increase in the length of time prisoners are locked up in their cells rather than engaged in regime activities, association and other purposeful activity. These factors together increase the distress which we know from research by the University of Cambridge is directly related to suicide rates. All of that was echoed in each speech made by noble Lords. I do not name all noble Lords as I cannot leave anyone out in that regard. 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.