Prisoners with serious mental illnesses naked in cells, lying in their own excrement. No showers or proper records of any intervention, including food.
Inmates with similar difficulties wandering idly around units or yards, some of them completely neglected and living in squalor.
Just some of the findings on the reality of many prisoners with serious psychiatric illness in an inspection report by a European detention watchdog.
In its 2019 report, a follow-on to its last audit in 2014, the Council of Europe Committee for the Prevention of Torture told Irish authorities that some of these situations could amount to “inhuman and degrading treatment”.
It comes as two cases currently before the courts highlight the extreme seriousness of this issue facing not just Irish prisons, but Irish society – an issue that has worsened in many ways in recent years and one that key players have repeatedly warned about.
The High Court heard on Monday that a man accused of murder, who is suffering from psychiatric issues, cannot be admitted to the Central Mental Hospital as it is full.
Last week, a Circuit Criminal Court judge said he was being put in a “terrible position” of being asked to release a man that was “probably unfit” to be on the streets because of a lack of space in the CMH.
The pressures facing the CMH – the country’s only national secure forensic psychiatric facility – is highlighted repeatedly in the CPT report and was the focus on a special report in the Irish Examiner last August.
The detailed inspection report followed visits to prisons in Cork, Cloverhill, Midlands, Mountjoy and Arbour Hill in September and October 2019.
Delegations also inspected two garda stations in Cork and three in Dublin as well as psychiatric institutions and social care settings.
But most of the focus is on prisons.
Many of the findings are complementary: an overall reduction in prisoner numbers and overcrowding generally; a reduction in violence in prisons and a marked improvement in health care services, including in substance abuse services.
It did highlight issues of overcrowding in certain prisons, the continued use of mattresses on floors (including in new prisons, like Cork) and lack of fully partitioned toilets in cells holding multiple prisoners.
#CoE #Anti-torture Committee (#CPT) publishes report on 2019 visit to #Ireland, examination of #treatment of persons detained in #police establishments, #prisons, #psychiatric hospitals and social care #homes @coe @CoE_HRightsRLaw https://t.co/HrYUgqwW9c— CPT (@CoE_CPT) November 24, 2020
But the bulk of concerns concentrated on how prisoners with psychiatric illnesses were managed in prison and, moreover, the lack of services outside prisons, in the community, for these people as well as ongoing lack of access to the CMH.
The CPT visited relatively new units that were set up in Cork (Vulnerable Prisoner Unit) and Mountjoy (High Support Unit) for inmates with psychiatric and other needs.
It said the VPU in Cork (six cells) was “sombre” with poor access to natural light and that the environment was noisy.
Prisoners were offered “no purposeful activities” apart from access to the exercise yard and there was “minimal staff interaction” with them.
In Mountjoy’s HSU (nine cells), the CPT said they were disappointed that there was still a “complete lack of structured activities” for these prisoners, saying that nearly all of them had “severe and enduring” long-term mental illness.
It said the proposed programme of activities remained “theoretical and unengaging”.
It said there was still no occupational therapy, individual or group psychotherapy or recreational therapy – only pharmacology (medication).
“In sum, the prisoners wandered idly around the unit or the yard and watched television," the report said.
It said that over the last 10 years the country’s largest unit for prisoners who are mentally ill – the D2 Wing of Cloverhill – has had to expand as “more and more severely unwell persons” have entered.
Cloverhill is a remand prison and takes those who are charged, and held in custody, pending trial.
On the first day of its visit, the CPT said the section had 29 prisoners in the 23 operational cells. Ten of the prisoners were on the waiting list for the CMH.
The report said: “Three days later, the unit was overflowing with seven prisoners having to sleep on mattresses on the floor, which the duty doctor said was a regular feature for the landing.”
It said the CMH in-reach team at Cloverhill assesses around 300 prisoners a year “of whom some 100 are actively psychotic”.
The report said studies had shown that the percentage of remand prisoners with psychotic disorders in Ireland (9.3%) was more than twice the percentage of prisoners with psychotic disorders found internationally (3.6%).
“Despite this evident increase in the number of mentally ill prisoners entering Cloverhill Prison, the resources provided for the care and management of these persons has been cut,” it said, adding that the mental health team “needs to be reinforced urgently”.
It said: “Further, the current focus seems to be solely around the psychiatric diagnoses, drug treatment and whether the prisoner is waiting for a place in a psychiatric hospital. On the other hand, there was a lack of discussion or planning about the day-to-day care of the men on D2 Wing.”
The watchdog said that a “major concern” is the rising number of homeless people ending up in prison and more particularly on the D2 Wing, which had risen to 32% in 2014 and closer to 50% in 2019.
“Many of the persons coming to D2 could be granted bail by the courts but because of their homeless status they are excluded from Health Service Executive (HSE) community mental health team services so they are left to languish in prison," it said.
“Moreover, their mental health condition continues to deteriorate as they are too ill to consent to treatment.”
It called on Irish authorities to put in place a comprehensive policy (i.e. one that includes housing, welfare, primary care, mental health care, substance misuse) in order to tackle this issue.
It added: “The CPT recommends that urgent steps be taken, including of a legislative nature, to ensure that mentally ill homeless persons in prison, who the courts are willing to bail, can be transferred rapidly to a psychiatric facility in the community to receive appropriate treatment.”
The delegation met two prisoners in D2 Wing, including one man who was naked in his cell, which was smeared in faeces and puddles of urine. He had no blanket, had not showered in two weeks or been let out of the cell.
There was poor records of any intervention, including food. The second prisoner was in a similarly distressed state.
@IrishPrisons welcomed the Report by the👉CPT on their 2019 visit to Ireland. @IrishPrisons welcomes the acknowledgement, made by the CPT, of the ongoing positive steps being taken by the Service since their visit in 2014 ⬇️https://t.co/RYaFDI1lZo— Irish Prison Service (@IrishPrisons) November 24, 2020
The CPT said that this situation “might amount to inhuman and degrading treatment".
It said that despite the completion of a new CMH, reports indicated that it will not result in enough additional beds to meet the demand.
In his interview with the Irish Examiner last August, the head of the CMH Professor Harry Kennedy said the biggest problem was that there were extremely mentally ill people in prison waiting to get into the CMH but that there was “almost no chance” of getting admitted before the end of their short sentences.
He said Cloverhill was the “trolley system for psychiatry” but said it did not “generate the rage” that people on trolleys in A&E did.
He confirmed that the welcome extra capacity of the new CMH would be filled within a few years.
“As a country,” he said, “we tolerate what no one else would tolerate – we currently have one fifth the amount of forensic beds that the British, the Dutch, the Germans and the Scandinavians have.”