29.07.1999

Imprisonment without trial

Riding on the back of recent high profile cases of ferocious attacks by deranged individuals, two weeks ago home secretary Jack Straw introduced ‘solutions’ to yet another perceived threat to the good order of Blair’s New Britain: the danger (note: not ‘potential danger’) posed by those with severe personality disorder. Many are to be arbitrarily labelled ‘dangerous’ - and thus a new bugbear of ‘dangerous severely personality-disordered’ (DSPD) persons spring forth ready-made amongst us - a putative, immediate threat which accordingly must be quickly dealt with.

Stripped of all decoration, Straw’s solutions mean imprisonment without trial or benefit of review, otherwise known as internment. Crystallising current Blairite thinking on this question, Straw launched a joint publication of the home office and the department of health, Managing dangerous people with severe personality disorder: proposals for policy development. This document states: “... for the relatively small number of severely personality-disordered people who represent an unacceptable degree of danger to the public, detention on the basis of the risk they present, and for as long as that risk remains, can be justified” (p6). Of course, asserting that those targeted are an immediate ‘danger’, and not merely a potential one, means this proposal has more chance of public acceptance.

At present, although the Mental Health Act 1983 ensures that many with severe personality disorder are compulsorily admitted to hospitals, this applies only to those who are assessed as likely to benefit from treatment. Thus, especially since clinicians are not always agreed on likely outcomes, there are many who fall outside the provisions of this act, since they are considered untreatable. The premise suggested by Managing dangerous people, however, is that a significant proportion of these ‘untreatable’, severely personality-disordered persons pose a present, distinct danger to the public and must be dealt with in emergency fashion. This, it asserts, must be tackled by changes in the law to allow executive incarceration and provide containment facilities for these individuals.

Straw’s proposals include two options, both of which supposedly “rely on the development of new, more rigorous, procedures for assessing risk ... [and] aim ... to ensure that the arrangements for detention and management focus on reducing such risks” (p3). Option one would change the law to prevent the release of DSPD people from prison or hospital while they continued to present a risk to the public; those receiving a custodial sentence after being convicted of a criminal offence would continue to be held in prison while anyone else (including those presently in no institution) would be held in a health service facility. Option two would operate under a new legal framework to provide indeterminate detention of all DSPD people (whether presently in prison, in hospital, or in no institution) in facilities run separately from prisons and the health service, as a new branch of the state.

Yet it is widely admitted, including within Managing dangerous people, that there is insufficient research evidence on the incidence of anti-social personality disorder, its prevalence in populations, the factors protecting against the disorder, effective interventions, or even the natural history of the disorder. Despite these crucial gaps of knowledge, and without any concrete foundation for these assumptions about the ‘danger’ posed by an unquantified number of individuals concerned, the Blairites intend to jump in with both feet and lock up individuals willy-nilly, merely on the say-so of a panel of experts determining risk under present hazy parameters, without benefit of legal safeguards or review procedures.

Clearly, if Straw is perceived as tackling recidivism and preventing violent crime in this way, then the Blairites can garner plaudits. However, theseproposals are dangerous, anti-democratic sops to an engendered panic. In fact, if recidivism were a concern, resources would flow in to rehabilitate offenders. But, as anyone who has recently spent time in prison can tell you, there are few skill or educational facilities, medical and psychiatric provision is very poor, and the over-stretched probation service can hardly cope.

In reality, Managing dangerous people proposes to misuse diagnosis of personality disorder to claim risk to the public, so that people who have committed no violent offence or may have served out their sentence may be kept behind bars. Incidentally, a good many of those who ought to be seeking psychiatric help will then fail to do so through fear of permanent imprisonment. In fact, in this cash-starved area of psychiatry, it has yet to be established whether certain types of disorder are indeed treatable or untreatable. This is a far from settled question.

The leading mental health charity, Mind, stated when these proposals were made public that the “central plank of the government’s proposal is the potential risk posed by a small number of people. In order to provide all of the right safeguards, to ensure that people are not locked up inappropriately or for longer periods than necessary, the way that risk is currently assessed needs significant improvements.” It seems clear that the current risk assessment procedures have severe limitations, so to base loss of liberty upon them is likely to produce serious injustices within the anti-democratic set-up that is proposed.

Straw and the Blairites have received brickbats from the conservative to the liberal bourgeois press over these policy proposals: “Think what a revolution we unleash once we accept potential wrongdoing as a basis for incarceration. Almost every one of us might, in some circumstances, commit a violent crime. For most of us the likelihood is tiny. But how large does it have to become to justify our arrest?” (editorial The Daily Telegraph July 20). And the Blairite-inclined The Guardian was also appalled at the proposals: “... a new indeterminate sentence ... would allow people deemed dangerous to be locked up, even if they had not committed any violent act. This must be resisted. Risk assessment is still far too imprecise a science” (editorial, July 20). Where might it end? After all, if the potential for wrongdoing is the measure for taking precautionary action in the draconian manner suggested by Straw’s ministry, then “almost every one of us” (the Telegraph’s words) could be under suspicion by our rulers. That is the enormity of what is being proposed in Managing dangerous people.

The government is not, after all, proposing urgently to provide clinical resources to deal directly with personality disorders to help sufferers integrate into society. On the contrary, it is setting up a punitive regime to clear the streets of potential miscreants and wrongdoers, as beggars and the homeless have been targeted in the recent past. And although government has helped establish the Institute for Severe Personality Disorder, this multidisciplinary body is a long way from producing study results, by which time so-called DSPD persons may well be suffering the effects of incarceration without benefit of either judicial process or the present Mental Health Act. Whatever their inadequacies, they do at least have in-built limits and review procedures.

Managing dangerous people is a paradigm for the way the state wishes it could manage us all.

Jim Gilbert