Lack of treatment for mentally ill prisoners needs to be 'urgently resolved' – report

The researchers said they received numerous reports of prisoners in 'acute phases of severe and enduring mental disorders' waiting for beds in the CMH and that some have 'remained in prison for up to 18 months'.

There are “significant concerns” among prison bosses and specialist psychiatrists that the new Central Hospital Mental will not be able to meet the demand from prisoners requiring therapeutic intervention, according to a Government-commissioned report.

The report said keeping these acutely ill people in prison jeopardised the safety of staff managing them.

The Health Needs Assessment for the Irish Prison Service (IPS) also found:

• IPS health staff struggle to get local community services to take responsibility for homeless people due to be released from prison, describing the services as having a “hands off approach” to homeless people suffering from poor mental health;
• About half of the prison population may be using, or seeking to use, illegal drugs, with the number “much higher” in some prisons;
• The “majority” of prisoners with an addiction problem also have significant mental health difficulties. 

The 119-page report, published by the ministers of justice and health, found prisons had “extremely poor” access to beds in the CMH, due to a lack of CMH resources, resulting in lengthy waiting lists.

“Though the number of CMH beds available to the IPS is set to increase with the opening of a new facility in Portrane, there are significant concerns within both the IPS and the CMH itself that the increase in CMH beds will not be sufficient to meet demand,” it said.

The researchers said they received numerous reports of prisoners in “acute phases of severe and enduring mental disorders” waiting for beds in the CMH and that some have “remained in prison for up to 18 months”.

The report concluded:

In our view, keeping prisoners within the prison system when they require urgent access to CMH in-patient treatment is clinically inappropriate, disruptive to the smooth running of the prisons, and unsafe from the perspective of staff, other prisoners and the individuals themselves who require treatment.” 

It said the issue needs to be “urgently resolved”.

The report said there were cases where clinicians were unable to intervene in a psychiatric emergency — such as giving a prisoner medication in situations where the inmate is unable to demonstrate consent — due to a lack of legislative support.

Treatment without consent

It said while “treatment without consent” for acutely disturbed prisoners was an ethical and legal concern, other European countries provided for it.

The report said a “significant” number of prisoners were homeless and many of them also have mental health disorders.

IPS healthcare staff said homeless people cannot get the help they need in the community with the result that people with “untreated mental illness” are offending and being imprisoned.

On release, IPS health staff typically struggle to get local community services to take responsibility: “This often results in the person coming back into prison very soon after release, with staff describing local authorities as having a ‘hands off approach’ to homeless people [with] poor mental health.” 

The report said opiates, alcohol, benzodiazepines and pain killers are used widely in prisons, not only affecting the health of prisoners but also creating the “potential for prisoners to go into debt” and the consequent risk of violence.

IPS staff said the “majority” of prisoners with addiction problems also have mental health difficulties.