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Prisons

My Lords, I, too, pay tribute to the noble Lord, Lord Ramsbotham, for instigating this debate. I declare an interest as an adviser to the trustees of the Sainsbury Centre for Mental Health. In these few minutes I shall concentrate on the area I know best in the prisons debate; namely, mental health issues in prisons. I suggest that what we can observe going on in the recognition and treatment of prisoners with mental illness is enough of an issue on its own—let alone everything else that noble Lords have talked about—to make it clear that we need a royal commission on our prisons to take a calm, dispassionate, expert and accurate look at what is going on, and to recommend, in a cross-party, cross-expert way, a true change of direction. Wearing my rather eccentric Prime Minister’s Champion for Volunteering hat, I am at present working on a review of volunteering in the criminal justice system. There are thousands upon thousands of wonderful men and women doing all sorts of incredible things as volunteers in our prisons up and down the country. The noble Lord, Lord Hurd, paid tribute to them. They get precious little thanks or chance to meet each other, but they are checked by the Criminal Records Bureau to ensure that they are the right people to do the job. Nevertheless, in some circumstances, a positive result from a Criminal Records Bureau check might give you just the qualification you need to be the mentor for some young offenders who are very troubled. They need to know what others who have been there have now discovered. I wonder if we should be thinking differently about that; a royal commission could do so. My other real concern is that those volunteers say that their freedom to work effectively in closed institutions relies entirely on the attitudes of the governors of those prisons. We should be under no illusions. That is one of the reasons why we need a royal commission. Prisons have become our last closed institutions. They are being used to warehouse people, many of whom should never have been there. As the noble Baroness, Lady Bottomley, said, perhaps it is for reasons of cost. The noble Lord, Lord Judd, has already said that there is a huge prevalence of mental health problems in prisons. Ninety per cent of prisoners have diagnosable mental health problems, compared to around 20 per cent of the general population. Seventy per cent have two or more mental health problems, compared with 5 per cent of the general population. That means that mental distress is both more prevalent in prisons and much more complex than in the general community. The default prisoner—the general, normal prisoner, as it were—is someone with a complex mix of mental health issues, substance abuse issues and other problems that have rarely been managed well by the public services. Yesterday the Sainsbury centre published From the Inside, a report on what prisoners and prison officers in the West Midlands have said about the impact of imprisonment and aspects of daily life in the prison environment which affect them. The prisoners said that they were most bothered by bullying, other inmates, having no one they trusted to talk to, substance misuse—a huge issue—unresolved past-life traumas and difficulty accessing services, particularly healthcare and counselling. What does this tell us? It tells us that mental health issues in our prisons will get worse and that both staff and prisoners know it. That, if for no other, is a reason for having a royal commission. There is one other issue that we ought to look at and a royal commission could examine. The Government are undoubtedly to be given credit for handing over prison healthcare to the National Health Service. We were all immensely relieved to see that happen not very long ago. At the moment, £20.8 million a year is spent on mental health care in prisons through NHS inreach teams; that is about 11 per cent of total prison healthcare spending, or just over £300 for each member of the prison population. The really worrying thing about that is that it is only about one-third of the amount required to offer what government policy stated it would do—that is, to give equal standards of care to those inside prison and to those outside it. We need a royal commission to look at this. As the noble Baroness, Lady Stern, pointed out, we are at the top of the league in spending on prisons, but towards the bottom on health. These people are sick. They need treatment. A royal commission could guide us in the right direction. I pay tribute to the noble Lord, Lord Ramsbotham, and very much support his proposal.