Mental Health Commission publishes report on access to mental health services within the Criminal Justice System
Locations
The Mental Health Commission (“MHC”), the Irish regulator of mental health services, has recently published its Report entitled 'Access to Mental Health Services for People in the Criminal Justice System' (the “Report”).
Findings
The Report has found that Irish prisoners and people in the community (i.e. past offenders) who require forensic treatment for their mental illnesses are not being afforded the same access to and quality of mental health care as the general population. Forensic psychiatric care deals with issues arising at the interface between psychiatry and the law and includes assessment of mentally disordered offenders, provision of expert evidence in civil and criminal proceedings and advice to general psychiatrists and other professionals. It aims to reduce the risk of reoffending, enhance mental health, and encourage a safe return to society.
Dr Susan Finnerty, Inspector of Mental Health Services and author of the Report, commented as follows:
“The right to healthcare is not negated by the fact that a person commits an offence because they were mentally unwell. The findings in this report show that people with a mental illness are being criminalised and this suggests the need for systemic change in both the criminal justice and mental health systems.”
“The right to healthcare is not negated by the fact that a person commits an offence because they were mentally unwell. The findings in this report show that people with a mental illness are being criminalised and this suggests the need for systemic change in both the criminal justice and mental health systems.”
A further finding in the Report related to the lack of diversion services. The aim of diversion is to identify persons with mental illnesses who come into contact with the criminal justice system and, where appropriate, ensure they are treated in a psychiatric setting rather than continuing through the standard criminal justice process. Dr Finnerty explained as follows:
“Many people who are mentally ill and who have committed minor offences can be appropriately and safely managed in general psychiatric healthcare settings. There is a lack of diversion for people who are mentally ill to local psychiatric services in Ireland and currently there are no pre-arrest diversion teams in place, unlike in other jurisdictions. This has resulted in people with mental illnesses coming before the courts for minor offences and ending up in the prison system. However, Irish courts should not be expected to act as a substitute for local mental health services in identifying mental illness and deciding on the most appropriate treatment. It is clear that resources must be put in place at pre-arrest, arrest and court liaison stages.”
In relation to the life of a mentally ill prisoner, Dr Finnerty explained that:
"There are long periods spent in isolation cells with no protection from the rules on seclusion as the decision to isolate a prisoner rests with the prison governor. We also found that mentally ill prisoners are bullied and victimised in the general prison areas, including having their medication taken from them, while they can often be forced to take illegal drugs. The report also noted that under criminal law legislation, prisoners cannot be forced to take medication, so prisoners who are seriously mentally ill remain untreated and become even more unwell. Added to this is the fact that prison officers are ill-equipped to deal with the complex needs of prisoners with mental illnesses, while mental health treatment programmes and resources are severely lacking.”
Inadequate Resourcing
The Report found that the courts can often be helpless when it comes to finding an appropriate placement for offenders who are mentally ill. At the time of writing the Report, there were 22 people on the waiting list for a bed in the Central Mental Hospital, Dundrum but it was noted that this figure can rise to 40 - and local mental health services are not resourced adequately to look after offenders who present with challenging behaviour.
A new centre in Portrane is in the course of being built with an increase in beds from 102 (in CMH Dundrum) to 170, including a unit for children and an Intensive Care Regional Unit. This brings Ireland's forensic beds from 2 per 100,000 to 3.5 per 100,000, which is still substantially lower than many other European countries. The Report notes that this is not a sufficient number now and will not be into the future, especially bearing in mind the absence of investment in other areas of general and forensic mental health care.
Recommendations
Dr Finnerty sets out 11 recommendations arising from the Report:
1. There should be a focused integrated government approach, producing a comprehensive policy on the provision of forensic mental health services into the future. This should include all areas of forensic mental health.
2. There should be a planned, coordinated and organised approach to provision of forensic mental health services nationwide, with a clear governance structure and equality of access throughout the country.
3. Prisoners with severe mental illness in prison should have timely access to treatment in appropriate clinical settings.
4. There should be adequate and safe staffing of all forensic mental health teams.
5. Mental health advice, training and assistance to Gardaí at pre-arrest, arrest, custody and initial court hearing stages should be provided.
6. A comprehensive pre-arrest and court diversion service should be provided nationwide, and this should be adequately staffed.
7. There should be a specialist team to accept referrals for assessment of people with intellectual disability in the prisons. This team should have a national remit and liaise with service providers to arrange diversions and/or release planning.
8. Co-ordination should be improved between local mental health services and forensic mental health services to provide a seamless transition along all steps in the care pathway. This should be responsive to the person’s needs, rather than catchment area concerns.
9. Legislative reform should be implemented to remove barriers to diverting remand prisoners and to facilitate hospital transfer on sentencing.
10. ICRUs Intensive Care and Rehabilitation Units should be developed in the south and west of the country to facilitate provision of appropriate care.
11. The recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment 2019 report should be acted on as a matter of urgency.
The full text of the Report can be accessed here.