These things happen

Mental Health Nursing,  Apr 2000  by Pollock, Laurence

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People

As a criminal barrister, Stephen Hesford's concern about the mentally ill led to his involvement in MIND. Then he got elected to Parliament. Laurence Pollock talked to him about the law, MPs' attitudes and the reform of the Mental Health Act.

There is a very fragile dividing line between our criminal justice system and the treatment of mental illness. Prison populations have

disturbingly high proportions of people who ought to be receiving treatment, whether in hospital or in the community.

Yet very few professionals - judges, lawyers, police - seem aware of the obvious link between these two causes of social exclusion - public lawbreaking and social norm-breaking.

The Crown Prosecution Service is still considering charges against the police who detained Roger Sylvester last year under the Mental Health Act. Sylvester died from his injuries a week after the detention. For CPNs the decision could be a significant pointer to how the authorities view the interface between law enforcement and care in the community

The MP Stephen Hesford, however, has already made his own journey from the well of the court to the prison cells and drawn sombre conclusions. Elected for Wirral west in 1997 he has all the hallmarks of the younger, professionally successful generation of Labour MPs elected in the 1997 landslide. He has deeply rooted convictions about mental health however.

He is now a member of the House of Commons Select Committee on Health which last month began hearings on mental health provision. The aim is to "examine the provision of NHS mental health services for people, including children and adolescents, with mental illness or personality disorders, including consideration of the relationship with secure units, high secure hospitals and prisons."

It is a topic Hesford feels passionately about.

"I have been practising as a barrister since 1981, specialising in serious crime. Increasingly, towards the end of the eighties, many of my clients had mental health problems. I felt there was a glaring

inappropriateness about how the system was treating them.

"One particular incident brought home to me the inadequacies of the system. I went to see a client in the cells before court proceedings. He was kicking out and was unable to speak. This was not the same lad I had seen earlier.

"Through his cell door window he could see into the cell opposite where his mate had committed suicide - he could see him hanging there. He was desperately try to attract attention but no one would come.

"When I told the judge this, he just said, `So what? These things happen.' "This reply does not address the

underlying problem but covers up the inadequacies of the system. Some individuals should not be in the criminal justice system, but it's a question of appropriate intervention including peripatetic mental health workers at police stations and better training for police and prison officers."

Hesford sees further dangerous spin-offs from the overlap between the courts and mental illness. The system's inability to fully understand some defendants, increased their chances of being remanded in custody. And other drawbacks in the current legislation lead to custodial remand for those with severe personality disorders.

"They are just dismissed by the psychiatric professionals as not treatable and are simply imprisoned. This in my view is wholly inappropriate." These experiences and impressions were behind Hesford joining MIND as an individual member in the north west. As someone with a legal background he lent assistance as and when it was necessary. In 1998 he was elected to MIND's national council.

"I do identify with MIND. I was particularly attracted early on to their 24-hour crisis care approach. That is very necessary and something we are moving towards.

"But I was shocked to learn how different the provision is in different areas, from none to patchy to very good. There is a huge health

inequality issue."

How then did entry into the House of Commons and the august corridors of Westminster change the perspective? "I was surprised by how little in practice those in parliament actually engage with outside bodies or particularly glaring issues."

Nevertheless the 1997 election saw one of the biggest changes in House of Commons personnel this century from all parties. Did this produce a sea change in attitudes among our national legislators?

"The last way you could describe mental health is sexy but I would like to think there are far more MPs who are sensitised to it as an issue. But I would not want to overplay this."

So the jury is still out on whether this volatile non-vote winning (unless you call for mass incarceration) issue is getting a better hearing in

parliament. Hesford has arrived with a hybrid and, in some areas vivid, expertise on the subject.

"There is pain and pleasure. First as a non-mental health professional no one can accuse me of having any baggage. But the pain is that specialists see you as an amateur.

"As a community health council member I visited various units in inner city Manchester which was very tough. Within the prison system I have seen a variety of specialist units for sex offenders and handled psychiatric reports." Whatever his experience though, a new Labour MP must feel the twin pressures of Millbank Tower orthodoxy and the claims of, say, the mental health charities which have developed a common front on proposals to change mental health law.