By. John Gunn, CBE, MD, FRC psych, FMedSci, Emeritus Professor of Forensic Psychiatry, KCL
Chairman, Crime in Mind
Introduction
Congratulations to the Times newspaper on setting up a review of the criminal justice system. A review is overdue, but you have set yourselves a daunting task. I was a member of the Royal Commission on Criminal Justice which had more limited terms of reference. We had two years and found that we could not cover everything but you have given yourselves only one year.
I will try to address your areas of concern but as you will probably have large volumes of evidence, I will try to make my points as brief as possible. I will mostly omit academic references but these can be submitted later if necessary. Before addressing your concerns, I want to make some general points.
The criminal justice system has been treated badly by successive governments yet it is a fundamental public service. It has suffered disproportionately from budget cuts and the first requirement for any reform is to provide adequate funding and staffing.
I am a psychiatrist and therefore my remarks will give an emphasis to mental health matters. This is not necessarily unreasonable as the criminal justice system deals with large numbers of mental health problems and to some extent prisons are becoming a dumping ground for psychiatric patients who are rejected by the NHS or for whom no bed is available. Forensic psychiatry needs to be an important part of your work but as luck would have it much of the spade work for this area has already been done and published. I refer to the extremely helpful and comprehensive review conducted by Lord Bradley[1] which gives a clear picture of the problems, facts and figures, and at least 68 recommendations. Admittedly it is slightly out of date in that it was published in 2009 but as governments have largely ignored it, most of it is still highly relevant and all its recommendations should be implemented.
Research is not on your list of concerns and yet progress will not be made without scientific evidence and knowledge. I will therefore add a short section on research at the end.
Policing and the culture of police
Policing needs to shake off its 19th century image of quasi male soldiers acting as tough guys. To do this it needs to reform its structures and its recruitment. It is generally agreed that it should be regarded as a service rather than a force. It needs to reflect and understand modern social conditions. At times incidents may arrive which require physical responses, including weapons but intellectual responses are just as important and probably needed more often. Its workforce should Include as many women as men and representatives from ethnic minorities reflecting their distribution in the British population as far as possible. High educational standards should be required, for example recruits should be, at least, expected to have advanced level qualifications, and a high proportion of officers should be graduates. A good deal of time and effort should be spent on training. I note the 25 courses that advertised by the College of Policing but it is not clear what proportion of officers enlist in these courses and whether the instructors include knowledgeable civilians; for example, it’s not clear whether the mental health course includes psychiatrists. Once upon a time I taught police officers on a negotiators’ course and it was clear that there was very little basic understanding of mental health issues amongst quite senior officers. That negotiators’ course is not listed and some other areas could also be usefully listed, such as community policing, stalking, cyber-crime. It is also not clear from the website how many police officers take these courses and who is eligible to do them. I believe that full professionalisation requires a specialist qualification and possibly a form of registration as happens in law and medicine. Provisional registration would be followed by full registration after an agreed educational course and satisfactory reports. This would set standards and individuals who significantly transgressed those standards would lose their registration and thus be unemployable in any police service.
The recruitment process should not only examine educational credentials but also consider evidence of community mindedness, such as voluntary work. Enquiries should be made exclude individuals with racist and sexist tendencies. Every effort should be made to check the veracity of a candidate’s curriculum vitae. References should be available at the time of the interview.
Police services deal with many individuals who are mentally disordered. They may be intoxicated with alcohol or other substances, deluded because of a mental illness, non-comprehending because of mental illness or handicap. Such individuals may be disruptive even dangerous. Unless a very serious offence has been committed, they are probably best dealt with at the earliest possible stage by diversion to mental health services. The problem with this approach is that mental health services are in short supply and often mental health professionals resist taking responsibility for mentally disordered offenders. Nevertheless, the ideal should be aimed for and wherever possible links should be developed between police stations and mental health services. Bradley recommends an emphasis on neighbourhood policing and the more widespread use of Safer Neighbourhood Teams. Bradley also notes that the appropriate adult scheme whereby a vulnerable individual because of age, colour, mental handicap, or other psychiatric disorder has an appropriate adult to support them at a police station, is underused or misused. More appropriate adults are required and they should be individuals who have had training in the role.
The Royal Commission I sat on was established to try and reduce the number of wrongful convictions. One major problem we noted was the reliance of detectives on confessions. For centuries a confession was the standard of proof required by a court and torture was used as a way of obtaining a confession. 20th century psychological research has shown quite conclusively that confessions are often misleading and wrong (see below). Yet miscarriages are still the occurring because of a reliance on confessions. Voluntary confessions maybe helpful in starting a criminal investigation but other evidence should be essential at the time of trial. Confessions obtained under duress are completely useless. The law should make this clear.
Having assisted the Metropolitan Police at the Iranian embassy siege I am very aware of the psychological pressures officers come under at times. They need support during difficult operations and they especially need support after those operations. I found that police officers suffering from post-traumatic stress disorder, a fairly common condition, would not report to the police health system fearing lack of confidentiality and loss of promotion prospects. Police services should develop relationships with local psychiatric services.
Multi-agency public protection arrangements (MAPPA)
Police also have a role in the aftercare of prisoners. The role and functions of MAPA groups has been set out very clearly in a Royal College Forensic Faculty report [FR/FP/01] I’m sure this can be made available to the Commission.
Knife crime.
Weapons control is an important element in the reduction of violent crime. Britain is fairly good at gun control but it is obviously lagging behind in controlling the availability of dangerous knives. Knives have many domestic uses, the knives used by young boys to protect themselves frequently knives have very little use except to harm others. New laws should be introduced to prevent the sale of such knives. This will be difficult because most of the knives are bought from the Internet. British companies making knives could be subject to laws and licences, but perhaps the only way to prevent foreign knives getting into young hands is to X-ray incoming overseas parcels. Domestic knives in England and Wales should usually be sold with a rounded tip rather than a sharp one, this would be a useful public health measure.
The youths concerned are frequently unhappy and frightened, they may be members of a young criminal gang or mixed up in drug dealing or simply alienated, from other boys. In areas where such social problems exist volunteers should be recruited to provide social distractions and preferably a youth club as well as, and counselling and referral to other agencies. Neighbourhood policing is particularly important so that officers can get to know young people and help them find recreation as well as direct them to local voluntary and social services. Youth services have had their budgets cut by 70% and knife crime has risen by 30%.[2] A close knowledge of young people in a particular area will enable the police to understand and intervene constructively with the drug dealing and gangs which young people lapse into when not otherwise occupied. Ensuring that truancy from school is kept to a minimum will also be helpful.
Violence against women and girls
The epidemiology of violence needs to be clearly defined. The British Crime Survey should help show the extent of the violence problem, and its variations. Domestic violence is different from attacks by strangers and from gangland activities. The causes of violence include mind altering substances such as alcohol, cocaine, and other drugs. The control of these substances should be seen as a priority and given appropriate resources. Alcohol is probably the commonest drug being used. No one is going to suggest making it illegal to drink alcohol, but it is comparatively very cheap and the drinks industry lobby is powerful. Price control is the best way to reduce consumption. Reduced consumption of alcohol will not only benefit health in general but will also produce a reduction in violence.
Domestic Violence
Domestic violence is probably the commonest kind of violence in our society. It affects both men and women but women are by far the larger number of victims. Reduction in alcohol consumption would be useful in this area. Frequently women being attacked at home do not know where to go or how to escape. Social and mental health services should be advertised and ready to assist and women’s refugees should be much more readily available. All this, of course, requires additional and dedicated resources. A particularly tragic form of domestic violence is extended suicide, when one member of a family, usually the father, becomes ill, decides that life is not worth living and that his whole family must escape further misfortune by death. Many of these psychiatric problems are not identified, better and more numerous services are required.
Two major psychiatric problems are often behind attacks on women. The first is pathological jealousy which is a serious psychiatric disorder which not uncommonly leads to serious violence and even murder. The other problem is stalking, again this is not sex specific but it is more commonly men who stalk women; stalking can lead to serious violence including murder. Very few services are available to assist women being stalked. Very few of the stalkers who are reported to the police are arrested, and only a few of those are imprisoned. Stalking services need to be established jointly between police and psychiatric services. The best example I know of this occurs in Melbourne Australia where the local psychiatric service has an established stalking clinic Not all stalkers will accept offers of help but many do and can be treated.
Chem Sex
A growing problem among younger people is so called “chem-sex” In which drinks are laced with illegal stimulants and sedatives, supposedly for enhanced pleasure, but the activity can lead to violent sexual assault. Sometimes drinks are laced surreptitiously so that the victim really has no choice. It’s an area of growing concern which has stimulated specialist police attention. The Sagamore Project is a joint initiative involving probation, the police, e prison service, and courts, as well as sexual health and addiction services, focusing on chemsex and related problem behaviour. It is a good example of inter-agency co-operation
Stranger Violence
Violence from strangers is usually a quite different problem. It may arise from stalking but most stalkers know their victims. Most lone attackers have abnormal mental states and many are frankly psychotic, others may suffer from autistic spectrum disorder. Sadly, a high proportion are already known to psychiatric services, some of these have been mismanaged or their risks have been assessed incorrectly. As with criminal justice services, psychiatric services are underfunded with insufficient resources. The pressures on NHS secure beds are immense and waiting lists of up to three years for an assessment for autism reflects dangerous under resourcing.
Psychotic Offenders
Secure beds are often used for long term patients who are ill but not necessarily dangerous because there are so few beds available for general psychiatry. This reduces the number of beds available for psychotic patients who are also offenders. Deluded lonely wanderers have always been feature of urban life. The Victorians developed some so-called “reception centres” in London for such people, these centres have been replaced by a service in which police officers identify such individuals and take them to a clinic for psychiatric assessment – the so-called Fixated Threat Assessment Centre. Usually, the patients collected are quite ill and the clinic tries to get them admitted to their local psychiatric hospital. (See below in causes of crime). Forensic psychiatry services are, like all psychiatric services, in short supply with insufficient beds and staff to identify, hospitalise, and treat potentially dangerous psychotic patients..
Cybercrime etc
Theft and fraud either by the telephone or on the Internet is an increasing problem which presents difficulties of identification. The fraudsters are particularly good at persuading people that they are assisting them and after a plausible story they can persuade an individual to move money from their bank account into a bogus bank account. It is easy to assume that this will only happened to a few gullible people but the statistics tell otherwise. A variation is to persuade someone, usually a man, to send naked or indecent pictures to a “friend” as part of a supposed exchange. The purpose is sinister however and the sender of the pictures may find themselves blackmailed to prevent their pictures appearing on the Internet. Policing these crimes seems almost impossible big cause the perpetrators give no indication of their whereabouts nor leave any traces, they can use many bogus telephone numbers or e-mail addresses that are largely unidentifiable. Perhaps specialist IT departments should be established by the police to find ways of tracing the whereabouts of the fraudsters.
Cyber bullying is receiving increasing attention throughout the world and may lead to self-harm including suicide. Specialist police attention needs to be given to this growing problem
Terrorism
I am not familiar with terrorism and anti-terrorism, but I am aware that the Royal College of Psychiatrists is involved with Prevent a counter terrorism agency within the Metropolitan Police which attempts to identify individuals who may be recruited for terrorism and divert them into other pathways. It is insufficiently recognised that bomb makers and political or religious fanatics are not always mentally healthy people working in groups and there is a significant minority of lonely unhappy, sometimes frankly ill individuals, who can threaten and attack with apparently extremist political and religious views. Some are suffering from autistic spectrum disorders others from psychosis still others from post-traumatic stress disorder. It is important to separate these individuals from the more organised terrorist groups as they may be amenable to care and treatment.
Causes of crime
The causes of crime are legion and very complex. Criminologists have done some important studies, particularly longitudinal studies on the causation of crime but research has been somewhat limited by funding and definite policy signposts do not easily follow. Nevertheless, it is now abundantly clear that anti-social behaviour leading to criminality commonly begins in childhood where home conditions and parenting are crucial. There may also be some genetic aspects determining behaviour. For example, Caspi, Moffitt and colleagues found in their New Zealand birth cohort study, that one genetic characteristic is protective against adverse childhood experiences. Farrington, using the Camberwell cohort study, has identified a number of factors that predict adult criminality. These are high impulsiveness, low school attainment, criminal parents, parental conflict, and growing up in a deprived, high-crime neighbourhood. There is evidence from the USA that legalising abortion produces a drop in the crime rate. There is also a growing body of scientific evidence on the effectiveness of early prevention programmes, in the USA, designed to prevent children from embarking on a life of crime. Preschool intellectual enrichment, child skills training, parent management training, and home visiting programmes are among the most effective early prevention programmes. There is also evidence that bullying in schools can lead to anti-social behaviour. Although a good deal more research to specify the nature and intensity of adverse factors is required, the available evidence suggests that early identification of vulnerable families followed by adequate social support and training is important. Likewise vulnerable individuals in schools should be identified early and given specialised or supplementary education. This means a focus on and better provision for social services departments.
Toxins
Mind altering substances are particularly harmful. Social and emotional development require optimal brain development and function, toxins introduced at any stage of life can lead to antisocial activity but this is especially true in children and adolescents. The commonest toxins which Interfere with optimal brain functioning are alcohol and illegal mind altering substances such as cocaine, opiates, cannabis, crystal meths, and many others. Further, damage by substances may have been done in utero foetal alcohol syndrome is particularly well documented. Alcohol is toxic to the brain at all ages but the damage done during the embryonic stage of development is particularly damaging and children born subsequently have a series of problems including an increased likelihood of criminal behaviour.
Alcohol should be the easiest drug to control as it is a legitimate recreational drug, but governments shy away from effective controls for several reasons. Alcohol is a widely popular drug and controls may lose votes, it is a significant contributor to national taxes and it is produced by a very powerful industry which can lobby politicians. A significant rise in the price of alcohol will produce a reduction in the NHS costs caused by its health damage, and a reduction in anti-social behaviour, especially violent behaviour. Poppy Koronka, health correspondent of The Times, reports the Institute of Alcohol Studies as saying that alcohol costs the criminal justice system £14.58 billion per annum.
Legalising cannabis may enable better control by licences and taxes but there is an argument that legalisation would also increase consumption which would offset the other benefits. However, controls would be able to deal with the growing problem of illegal growers producing stronger and stronger strains of the cannabis plant so that the relatively mild mind altering properties of naturally grown cannabis are replaced by strains which severely affect mental health including inducing psychosis. A systematic review of the impact of legalising or decriminalising cannabis in other countries would be very helpful
Opiates have definite medical indications but a large black market has developed. Probably the only way to curb this is to establish plenty of drug addiction clinics which will dispense free opiates, as is done in Portugal. Dosage and adverse effects can be controlled that way and many addicts can be weaned away from heroin etc. Other drugs need to be carefully researched to ascertain their prevalence and to discover pointers towards control. Suggestions such as these tend to frighten governments because they sound very expensive but the economics of drug use and it’s criminal marketing is poorly understood. Reductions in drug use, especially alcohol would produce significant savings. Drunk and alcohol services are in extremely short supply and the significant development could prevent a sizeable number of crimes.
Traumatic Stress.
Another psychiatric problem which needs attention is the stress produced by trauma. When it is looked for, traumatic stress is discovered in a high proportion of prisoners. The traumas concerned are frequently childhood traumas but adult trauma can also produce crippling anxiety, withdrawal, and aggression. When I was treating patients who had been through severe travel disasters such as the Herald of Free Enterprise capsize, the Clapham rail disaster, or the King’s Cross fire, I came across a significant number of people, who had previously lived law abiding lives, who committed violent crimes and were sent to prison following the disasters because of the rage attacks they developed as part of the post-traumatic stress. Inquiries of personal histories when I was working for the Parole Board revealed many prisoners who were suffering from post-traumatic stress, whose condition had not been identified, and therefore remained untreated.
Neurodiversity.
As the mysteries of the diagnostic rubbish bin of “personality disorder” are slowly unravelled it has been found that a significant number of people with this diagnosis are actually individuals who have neurodiversity. This is a very broad group of conditions varying from mild dyslexia to severe autism, it includes people with attention deficit hyperactive disorder [ADHD], pathological excessive anxiety, rage attacks, and severe obsessional disorder. Not all of these conditions reach “illness” levels but special arrangements may be needed in many cases, for example in educational classes, but some people have such a noteworthy variation of brain function that they require psychiatric and psychological help if they are to lead satisfying and law abiding lives.
Psychosis.
I have already mentioned the important relationship between violence and psychosis. Psychosis is a continuing and alarming and largely preventable form of violence occurs in a few psychotic individuals. These are people who suffer from delusions, hallucinations, and paranoid ideas. They may make homicidal attacks in order to deal with the delusional threats they perceive. As a proportion of the launch number of people with psychosis violence is relatively uncommon but a recent Sunday Times article by Sean Linton uncovered 233 homicides by psychotic individuals in a four year period. Most of these were preventable; the psychosis had already been diagnosed or at least noticed. Many of the patients were not admitted to hospital, as they should have been, because of a shortage of beds or in some cases a fallacious belief that the psychosis could be managed in the community. Psychiatric services are chronically underfunded and basic requirements such as hospital beds are often not provided by NHS authorities even though they have a legal obligation to do so. To put it simply hundreds of lives can be saved if adequate forensic psychiatry services are provided supported by adequate inpatient facilities.
Mental Handicap.
The final, but by no means least important, psychiatric problem I will mention here is intellectual disability. Some people have brains which are slow in acquiring information and skills which leads to rejection by others and considerable frustration which in turn may lead to bad temper and lawbreaking. Too many such people are discovered in prisons and very few of them are referred to appropriate services. As with all psychiatric conditions early diagnosis and medical help is essential.
The court system
Financial cuts and political neglect have led to a dire situation in the court system with a huge backlog of cases to be heard. If there is anyone on the Commission who has not read The Secret Barrister then I would strongly recommend doing so. The book outlines gross deficiencies at every level in the court system. There is a shortage of premises, a shortage of judges and other lawyers and an unfair and inadequate legal aid system. It is obvious that financial remedies are urgent and that the court system needs to be promoted up the political agenda. I like the rapid remedy suggested by Dame Anne Rafferty, of pop up courts as an interim measure. Obviously, this needs to be accompanied by an increase in the staff to run such courts and a much more generous legal aid system.
As already indicated, there is a close connection between mental health and offending. It is, of course, not true that all offenders have mental health problems but many do. A study in Manchester suggested that of 698,000 bailed people directed to appear at magistrates’ courts in 1998, 9,143 people will have a serious mental illness; and of 123,000 people held in custody until their first court appearance, 8,081 people will have a serious mental illness[3] [4]. Many of these people should be diverted into the health system. To do that an effective diversion scheme must be available in every court and NHS facilities should be available and willing to accept the diverted cases. To effect such schemes properly, both magistrates and judges will require a lot more psychiatric instruction than they currently receive, but the key is the provision of psychiatric beds, psychiatrists, nurses, and other mental health personnel in sufficient numbers.
Confessions.
As mentioned above, confessions have been at the heart of criminal convictions for centuries. Before forensic science emerged, it was the basis of the majority of criminal convictions. Confessions were frequently extorted by duress and torture. Psychological science has, however, shown them to be highly unreliable[5] . False confessions were at the root of the miscarriages of justice which led to the Royal Commission on Criminal Justice [RCCJ]. I firmly believe that confessions alone are inadequate to secure a safe conviction. Other evidence should be sought and presented at the trial. In spite of the RCCJ recommendation that judges should give warnings about the dubious safety of confessions, cases of miscarriages of justice caused by false confession are still coming to light.
Juries.
Only a very small proportion of criminal cases are tried by juries; these, however, are the most serious cases. Very little is known about the workings of juries because research into their workings is forbidden by law. The first recommendation of the 1993 Royal Commission was “Section 8 of the contempt of court act 1981 should be amended to enable research to be conducted into juries’ reasons for their verdicts.” It has not been implemented but it should be, and I would add that juries should be required to give their reasons for their verdict, in writing, to the judge at the end of a trial.
Private prosecutions.
The recent Post Office scandal of many miscarriages of justice suggests that private prosecutions should be stopped and that all prosecutions should go through the Crown Prosecution Service. This will require extra funding of course. A major factor in inadequate criminal justice is funding. Courts and their staff are underfunded and legal aid funds I’ve been so reduced that lawyers in the criminal justice system are unable to make a reasonable living and so divert to other branches of law.
The Criminal Cases Review Commission.
The one RCCJ recommendation that was universally welcomed was the establishment of a new body outside the court system, and independent of government, to examine alleged miscarriages of justice after they have been rejected by the Court of Appeal. This body known as the Criminal Cases Review Commission (CCRC) started off well but in recent years it has become a disappointment as the referral rate of alleged miscarriages is much the same as the Home Office referral rate before the RCCJ report. Wrongly convicted unfortunates like Andrew Malkinson have struggled to get the CCRC to investigate their cases fully and the rate of refusing potential cases is quite high. There seem to be several reasons for this. The Commission is no longer a full time activity for its members who tend to work on a part time basis, often from home. Like many other criminal justice organisations, the CCRC has suffered substantial financial cuts. Thirdly the Commission seems to be approaching potential cases in the same legalistic manner as does the Court of Appeal. It is not surprising, therefore, that it tends to agree with the Court of Appeal rather than taking a fresh broader view of the case without the constraints of legal precedence. The Royal Commission envisaged that although it would be able to take legal advice the new body would mainly comprise people who are not lawyers so they could add a different dimension.
Because of these concerns the All-Party Parliamentary Group on Miscarriages of Justice set up The Westminster Commission on Miscarriages of Justice in 2019. They said among other things “The CCRC is …… operating in a completely different way from that envisaged and provided for in its legislation………..In our view, significant funding cuts alongside an increasing caseload have left the CCRC under-resourced………There should, as anticipated in the legislation, be a mix of full- and part-time Commissioners, on a salaried basis, for five-year terms and with a minimum of three days per week……It may be thought that the CCRC exists to refer cases to the appeal courts where it believes a miscarriage of justice may have occurred. In fact, its remit is more limited. It must consider that there is a ‘real possibility’ that the conviction, verdict or sentence would not be upheld and, unless there are exceptional circumstances, the applicant must have exhausted their appeal rights and there must be fresh evidence or argument not taken at trial. The ‘real possibility’ test is problematic………a different test might create a different and more independent mindset………applicants should be provided with at least a quarterly update that sets out the progress against the case plan, the current activities being undertaken, reasons for any delays or lack of progress and the current case completion estimate, a Provisional Statement of Reasons should be issued in all cases to give an applicant and/or their legal representative the opportunity to respond.
Sentencing and the judiciary
In Europe Great Britain has the dubious distinction of incarcerating the highest proportion of its citizens other than Turkey, Russia and Gibraltar; 147 per 100,000 of its citizens are locked up. The two Irish countries lock up 95 per 100,000 which is the overall average for the rest of Europe. The northern European countries have an average of 79 per 100,000, which is nearly half of the rate of Britain. It seems unlikely that Britain is less law abiding then say Germany, France or Italy, so there must be another factor. Our prisons are overcrowded and politicians seem to think this is related to too many offenders receiving short prison sentences. In reality it is the growing average length of prison sentences which keeps the numbers of incarcerated people high. Slightly shorter sentences for serious crimes would reduce the total number of incarcerated people. This of course would horrify the newspapers and probably MPs as well but there is no evidence that length of sentence is directly related to the level of crime in our community. At the very least there should be a study of the relationship between prison sentence length and crime rates, and international sentence practises could be looked at with advantage
Indeterminate Sentences.
The crime of murder currently carries a mandatory sentence of life imprisonment. This should be changed so that judges could sentence murderers in the same way as other serious offenders. The current debate in the election campaign concerning new laws for the sentence sing of murderers is an irrelevance. Life imprisonment is an indeterminate sentence, so there is no need for other types of indeterminate sentence such as the recently discredited indeterminate sentence for public protection [IPP] which has now been abolished, leaving a large number of socially and mentally handicapped people in prison largely with little hope of ever being released. Many of those released on licence are rapidly recalled because they find freedom difficult not because they have committed a crime but because of poor social skills. Under the Victims and Prisoners Act 2024 the Secretary of State can rerelease them, but this does nothing to address the injustice of IPP prisoners remaining in prison because of their poor mental health.
Hope is an extremely important human incentive and, it seems to me, should never be removed entirely. People change, circumstances change. Most life sentence prisoners live with the hope that at some point they will be able to serve the remainder of their sentence in the community on licence. Sometimes judges remove hope from life sentence prisoners by declaring that a prisoner should never be released; this is cruel, removes all incentives for rehabilitation and makes management of such an individual more difficult. Some people will have to stay in prison for the whole of their life because they remain dangerous or because their life would be in danger if they were released, but this shouldn’t be decided at their trial. Such judgments are best left to the Parole Board who will make up-to-date evaluations towards the end of a life sentence.
The Judiciary.
I would like to see the judiciary more closely involved with the criminal justice system. For example, it might be useful for all judges to have a prison visiting responsibility, not in any way to inspect prisons, but to enable them to discuss with the staff some of the problems presented by imprisonment and also to hear from some of the prisoners about their experiences. When a long sentence has been given, it might be helpful for the judge giving the sentence to review the case after, say, five years; s/he would be able to get some feedback on progress and, even, maybe adjust the sentence in the light of the information received at the review. I note that the Sentencing Council has now issued a guideline on sentencing offenders with mental disorder
Special Sentencing.
When I was in practice, I used a very helpful legal device to treat and control some of my mentally disorders patients who had committed offences. This was a probation order with a condition of treatment. It was voluntary on the part of the offender, the probation officer, and the psychiatrist. It worked very well in many cases that might otherwise have been sent to prison. This was replaced by the Criminal Justice Act 2003 with a Community Order which has 12 different requirements that an offender can be ordered to complete. These vary from unpaid work to attendance at an attendance centre, and include drug rehabilitation, alcohol rehabilitation, and a mental health treatment requirement. The mental health treatment requirement replaces the old probation order with a condition of treatment but Has been rarely used until recently. An interdepartmental group, led by NHS England, has promoted MHTRs which can be managed under primary care. MHTRs for the people who need specialist psychiatric treatment have been much harder to implement. Again, a limiting step appears to be the scarcity of psychiatric resources. If used more often the MHTR would be likely to stem the flow or inappropriate short term imprisonment for offenders with mental disorders.
There is a view that courts, especially magistrates’ courts should include a range of specialist courts. The ones suggested include drug courts, domestic violence courts, mental health courts, and community courts. These would include specialist judges, and a local system of services to which an offender could be referred. Progress of a community order with particular requirements could then be continually assessed by probation officers and occasionally reassessed by the sentencing judge. Examples of the few places that have tried these arrangements are given in the Bradley report. The success of such schemes would depend on services being available and continuity of staff so that the probation officers concerned and the judge could get to know and follow the individual cases. Personally, I think such ideas are excellent; but they should be properly funded, relevant services should be developed, and probation and judicial staff should be trained for the job concerned. I don’t see why it is necessary to give them separate names. It is fairly obvious that individuals with drug and alcohol problems will usually have other mental health problems and that domestic violence is frequently fuelled by drugs and mental ill health. It seems to me that the key issue apart from the provisions mentioned is an effective liaison and diversion service. In other words, before the court hearing begins the person charged should meet with probation and psychiatric staff who can then advise the presiding judge the nature of the case and the services required. In the case of someone with a mental disorder or serious drug or alcohol addiction, a psychiatrist should be consulted to either take the patient into a mental health service or advise that a court direction should be made under the Mental Health Act.
Prisons, probation and rehabilitation.
“The degree of civilization in a society can be judged by entering its prisons“
Fyodor Dostoevsky
“The mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of the civilisation of any country. A calm and dispassionate recognition of the rights of the accused against the state and even of convicted criminals against the state, a constant heart searching by all charged with the duty of punishment, a desire and eagerness to rehabilitate in the world of industry all those who have paid their dues on the hard coinage of punishment, tireless efforts towards the discovery of curative and regenerating processes, and an unfaltering faith that there is a treasure, if you can only find it, in the heart of every man-these other symbols which in the treatment of crime and criminals, mark and measure the stored up strength of a nation, and our sign proof of the living virtue in it.“
Winston Churchill (Home Secretary) House of Commons 20 July 1910
As the membership of the Commission includes an ex-inspector of prisons it won’t need me to emphasise the deplorable state of our prisons. They are overcrowded, underfunded, understaffed, insanitary, and unloved. Funding and staffing should be improved immediately and dramatically. The numbers of prisoners need to be reduced urgently. In November 2020 in an interview with Ginny Dugarry in The Sydney Morning Herald, David Hare (the playwright) quoted Michael Gove MP, who was Minister of Justice in 2016 as saying “this is totally ridiculous. We’re putting ludicrous numbers of people in prison. We are incarcerating more people than anyone in Europe and twice as many people as we did 20 years ago. It is hideously expensive and it doesn’t work, any humane or sensible politician who became Minister of Justice would want to do something about that”. Mr Gove planned to introduce a prison reform bill. He was moved from the MOJ before he could do that. I have already suggested three important ways in which prison numbers could be reduced. Firstly, short sentences should be replaced by community orders, but the biggest cause of overcrowding should be tackled head on which is the length of prison sentences, long sentences are very expensive and there is no evidence that they work better than shorter ones. Thirdly severely mentally ill patients should be moved from prison to hospital. I have carried out several surveys of mental disorder in prisons and it seems that approximately 3% of prisoners, using clinical criteria, should be moved into NHS hospitals[6]. This does not happen at the moment for two reasons; there are too few psychiatric services, especially inpatient services, available and there is resistance from general psychiatry staff to take patients who have broken the law. When asked about this many general psychiatrists will say that prisons should be designated as hospitals so that the arrangements allowed under the Mental Health Act such as compulsory medication, would also be allowed in prison. To do this would be a tragic error with long lasting damage. Prisons are not hospitals; they are designed to punish and they cause harm. Hospital treatment includes psychiatrically trained nurses as well as psychiatrists, psychologists, and occupational therapists; above all its ambiance is recovery and rehabilitation. The sterling efforts of prison officers, prison nurses, and visiting psychiatrists cannot replicate the therapeutic environment of a hospital. If someone falls ill with a serious physical condition they are usually transferred to a hospital; the same should apply to severely mentally ill people, psychiatric patients should not be discriminated against. A useful insight into the work of a prison doctor is given by Amanda Brown in her book called The Prison Doctor (2019 – Harper Collins).
Addictions and sexual deviations.
Other mental disorders, such as alcohol or drug addiction, would also benefit from transfer to psychiatric services in the NHS If better services were developed. There are almost no services in the health service for sex offenders but these too should be developed. For some time, the prison service has relied upon sex offender treatment programmes which are usually group discussions. There is no evidence that they make much difference to sex offenders but the more recent programme at HMP Whatton, a medical programme developed with the help of NHS psychologists and psychiatrists seems promising, and if research demonstrates its efficacy, it should be more widely developed both in the prisons and in the NHS.
Suicide.
Suicide is a very difficult problem for prison authorities. Suicidal behaviour is undoubtedly linked to the high prevalence of mental disorder in prisons but there are also other factors such as isolation and hopelessness. In prison, staff at every grade should learn suicide prevention policies and a group of prison officers should be specially trained to provide support and counselling from prisons with suicidal ideas. There should also be scheme for training and using prison “buddies”, trusted inmates who can be called upon by other prisoners in crisis, day and night. All prisoners should have a personal officer who gets to know them and their individual problems. This requires prison officers to have some specialised training.
Education and rehabilitation.
All prisons should have educational and rehabilitation functions including specialised courses for work training, both white collar and blue collar. Illiteracy should be identified and remedied. Special arrangements should be made for mentally handicapped prisoners and for the growing number of individuals who are labelled as “neurodiverse” i.e. are on the autistic spectrum coping with such problems as dyslexia and lack of empathy. More specialist prisons should be developed, Grendon prison is a therapeutic community which works well with non-psychotic prisoners, Whatton prison specialises in the treatment of sex offenders, Blantyre house used to be a semi open prison enabling men at the end of their sentence to work in the community, but it has been closed. More imaginative use should be made of the prison estate, for example weekend imprisonment might be an effective punishment that does less harm by allowing a prisoner to continue work and remain with his/her family. Conjugal visiting should be allowed for long term prisoners who are not eligible for temporary release on licence.
Probation
Probation was privatised in part a few years ago and this virtually destroyed it as an effective agent of criminal justice. It needs to be re-established as a coherent profession. When functioning well probation can reduce or prevent crime and assist with the rehabilitation of offenders. Services probably run best on a regional basis, ideally overlapping with police services. Every prison should have close relationships with probation staff, and some probation officers should work within prisons and liaise with their counterparts in the community. Each prisoner should relate to a very small number of offender managers [probation officers] who should have caseloads of offenders both in prison and in the community such that they can form individual relationships with those offenders to assist them with accommodation, work, and personal problems. In many cases offenders will have mental health problems as well and so probation officers need to develop close relationships with their local mental health teams. Training for probation officers should include some psychiatry and psychology.
Research
You don’t list research as one of your key topics but I think you should. I have emphasised that the criminal justice system has inadequate resources, both money and trained staff, but it also has a shortage of knowledge. Speaking as a physician it is depressing to see other branches of medicine making great strides with new knowledge, for example the remarkable achievements in oncology and cardiology, while psychiatry lags behind. Cancer Research and heart research have well funded charities providing vital grants and staff. Psychiatry has very limited non-governmental funds, it simply doesn’t have the same public appeal; forensic psychiatry is particularly unloved as a charitable target. I think criminology is similarly placed. Some colleagues and I have established a new small charity, Crime in Mind, to raise funds for research in the areas which interest this Commission. There are probably no votes in funding research in unpopular areas of psychiatry and psychology from the taxes but it might be useful if the Commission could point out to government that help is needed even if, as I predict, they are unwilling to increase research budgets from taxation.
Summary
The main themes I have alluded to are funding and staffing. Fulsome attention to these will be expensive and unattractive to chancellors. Yet crime and mental health are also very expensive. I’m not an economist but I suspect that if the correct calculation could be made between assessing funding for the criminal justice system against the savings that could be made from lower rates of crime, and less dependence on prisons, the costs might not seem so astronomical. In any case an efficient criminal justice system should be regarded as a public service alongside other public services such as the National Health Service. Low crime rates and proper justice are essential components of a civilised society, unfortunately they cost money. An example of economic naivety is the Labour Party proposal to build 20,000 new prison places. It will be a costly error and do nothing to reduce crime. The money could be spent on recruiting and training more prison officers, improving education and rehabilitation in the prisons, recruiting and training more probation officers, and providing more hostel accommodation for ex-prisoners and offenders serving community penalties. The judiciary could be encouraged to use more community penalties and to reduce the length of prison sentences. All that stands a better chance of reducing crime.
Training is a matter I have alluded to several times; better results will almost certainly be obtained by better training of all personnel who are involved in crime prevention and the management of antisocial people.
I have also emphasised the importance of proper psychiatric care running alongside the criminal justice system. Crime and mental health are not one in the same thing but they are interrelated and for example proper NHS facilities for antisocial people will relieve the pressures on the police, the courts and prisons. This is a pragmatic way of looking at these matters but society he should be enjoined to treat all mental disorders even when they afflict unpopular people.
John Gunn
[1] Bradley, Lord (2009) The Bradley Report. Dept of Health, Central Office of Administration
[2] Russell Jones (2022) The Decade in Tory. Unbound, London
[3] Shaw J et al, (1999), Prevalence and detection of serious psychiatric disorder in defendants attending court, Lancet, Vol 353, pp 1053–1056
[4] Bradley, 2009, The Bradley Report
[5] Gudjonsson G H (2009) The Psychology of Interrogations and Confessions. Wiley, Chichester
[6] Gunn, J. Maden, A. & Swinton, M. Treatment needs of prisoners with psychiatric disorders BMJ 1991;303:338