Prisoners 'at risk of harm' from critically low number of mental health staff
The damning report on psychiatric care in the Irish prison system was issued by the chief inspector of prisons, Mark Kelly. Picture: iStock
It follows a damning report on psychiatric care in the Irish prison system by the chief inspector of prisons, Mark Kelly.
It documents “critically low” numbers of specialist mental health staff and says the lack of care for inmates with serious psychiatric illnesses places not only them but also other prisoners and prison staff “at risk of harm”.
Mr Kelly said his report should be a “clarion call” for action and said it follows a long-standing under-resourcing of psychiatric services, both in prisons and in the wider community.
In his cover letter to Justice Minister Helen McEntee, the inspector outlined the “fundamental problems” facing the system:
- Critically low numbers of specialist mental healthcare staff;
- Inadequate environmental conditions in some prisons, including overcrowding and dilapidation;
- Deficiencies in mental health treatment in prison;
- Gross lack of clincial pathways to access necessary treatment outside prison, including in the Central Mental Hospital.
Mr Kelly said the Irish Prison Service had “verified the factual accuracy” of his report and said “greater engagement” between the Department of Health and the Department of Justice will be “critical” to address the problems.
He said the action plan in his report should be placed on the agenda of the next meeting of a steering committee, jointly held by justice and health, which was set up to implement the report of the High Level Task Force (HLTF) on Mental Health, Addiction, and Prisons.
Mr Kelly said neglect in the treatment of prisoners with psychiatric difficulties results in potential human suffering, which, could, on occasion, “be construed as ill-treatment”.
He said: “Within Irish prisons, despite the best efforts of many dedicated prison and clinical staff, prisoner-patients frequently experience sub-optimal clinical treatment, due to the environment being inappropriate to their needs and a widespread lack of clinical staff which prevents the delivery of the necessary range of psychiatric treatments.
“Further, some prisoner-patients experiencing serious mental illness refuse the anti-psychotic medication prescribed for them and, as such medication cannot be legally compulsorily administered to them in a non-hospital setting, they then languish suffering and untreated in custody.”
He said prisoners whose condition is so severe that they require transfer to hospital — and put on waiting lists — can face long delays.
“[They are] left waiting for very many months on end in dilapidated and sometimes overcrowded prison cells — and on occasion in conditions which could be considered degrading — prior to their transfer.
"Indeed, many prisoners whom clinicians in prison deem to require transfer, never actually make it to a psychiatric hospital, either because it is thought fruitless to even refer them, due to a lack of any realistic possibility that they will be accepted, or an absence of any appropriate hospital facility or bed offer," Mr Kelly said.
“Some of these vulnerable and untreated individuals, on release from custody at the expiry of their detention, are then at high risk of falling through the net of community follow-up, sometimes returning to marginal existences with high risk of homelessness and substance misuse, their cycle of re-offending, re-imprisonment and lack of clinical care starting all over again.”
Mr Kelly said staffing levels can be so low that, on occasion, it results in “neglectful care”.
He said: “Urgent action is required to improve access to in-reach psychiatrists and specialist mental health nurses (and in one prison, IPS general nurses), psychologists, occupational therapy staff and other relevant staff.”
He said overcrowding and physical dilapidation can affect the privacy and dignity of prisoners and even “cause further deterioration” in their mental state.
He said that the “widespread lack” of a full range of therapeutic services results in prisoners “often depending solely on pharmacotherapy”.
The inspector said access to treatment in external hospitals was key: “Better diversion and easier access to the CMH and civil psychiatric hospitals is needed.
"This will require systemic changes, led by the HSE, with more beds opening at CMH, a clinical culture change, the opening of long-awaited regional secure hospital units, new designation of hospital units other than the CMH, and the possible use of the independent sector.
“Further, the proper care and treatment of prisoner-patients who are homeless must finally be effectively addressed.”
Underpinning all these problems he said was an apparent “long-standing under-resourcing of mental healthcare services for prisoners within prisons and in HSE civil psychiatric hospital mental healthcare services, as well as an apparent lack of consistent system-wide political will, prioritisation, accountability, and governmental drive to fundamentally address the relevant failings effectively and assertively".
He said this issue must now be an urgent priority: “The time for working groups and reports alone must draw to a close, action is now required.”
Reacting, Mental Health Reform said the report exposed “alarming deficiencies” in the Irish prison system.
“The findings of the Office of the Inspector of Prisons are deeply disturbing,” MHR CEO Fiona Coyle said.
"It is clear that the State is failing many people in the criminal justice system with mental health difficulties. The inhumane conditions and inadequate care in the prisons indicate serious human rights violations.”
She called on the Government to invest in community mental health teams in police stations and courts, which would help to divert vulnerable individuals from the criminal justice system towards supportive environments.
She said there has been progress, including the opening of the new Central Mental Hospital in Portrane, north Dublin, and the publication of the HLTF and an implementation structure.
Irish Penal Reform Trust executive director Saoirse Brady said it makes for a sobering read stating: “As mental healthcare in the community fails people who need treatment, what we’re seeing is people with high-level healthcare needs inappropriately being placed in prison as supports and care are not available in the community.
"Not only is it adding to record levels of overcrowding in prison, but it is also compounding the issues faced by the prison system — from overstretched staff, people placed in overcrowded cells in unacceptable conditions, and pressures in accessing support services and healthcare."
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