Court psychiatric reports can lead to lifelong consequences for minor offences

At the heart of this issue lies a simple but vital principle: medical confidentiality. It is the foundation of trust between patient and doctor. Without it, people do not speak freely. Without it, care breaks down

The court practice of asking prison psychiatrists for reports must cease. File picture

The recently published annual report of the Inspector of Prisons paints a stark picture of Irish prisons, branding the overcrowding within the prison estate a "national disgrace". The inspectorate additionally flagged high rates of perceived discrimination and inter-prisoner violence.

Each of these issues has the potential to disproportionately impact persons with mental illness. For many persons in Ireland who are living with a mental illness, stigma is already a real concern. This is amplified if there is contact with the criminal justice system.

A prison sentence is meant to take away your liberty — not your privacy, your dignity, and your future.

Imagine living with a serious mental illness. You make an error of judgement and find yourself in prison, charged with criminal damage after breaking a window. You are distressed, hearing voices, struggling to cope. You decide to seek help. A prison GP refers you to a psychiatric clinic. You speak openly, honestly, trusting — as anyone would — that what you say is confidential.

Why wouldn’t it be?

At your next court appearance, a psychiatric report is directed from the prison. At a subsequent hearing, in open court, your diagnosis — schizophrenia — is read aloud. Your name and address are included. Local media report it.

In that moment, the punishment changes.

What began as a loss of liberty becomes something far more enduring: the public exposure of deeply private medical information. Shame follows. Silence follows. You resolve never to speak so openly to a doctor again.

Your neighbours now know. Your children may face bullying. In prison, you may become a target. Beyond prison, doors quietly close — to employment, housing, travel, to ordinary life.

Even the original victim — whose window was broken — may feel uneasy. They sought proportionate justice, not a sentence that extends into lifelong stigma for you and your family.

This is not hypothetical. Versions of this scenario are unfolding in Ireland today.

The consequences are profound. Some individuals disengage entirely from mental health services. Some experience increased victimisation in custody. A small but significant number may attempt suicide. What is intended as justice risks compounding harm — not only for the individual, but for families and communities.

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At the heart of this issue lies a simple but vital principle: medical confidentiality. It is not a courtesy. It is the foundation of trust between patient and doctor. Without it, people do not speak freely. Without it, care breaks down.

International ethical standards are clear: doctors involved in a person’s care should not also be asked to prepare reports for court. The roles of therapist and evaluator must remain separate.

Courts have alternatives. Where medico-legal reports are required, they can and should be prepared by independent practitioners, with explicit consent. The practice of asking prison psychiatrists for reports must cease. 

Further, in-camera hearings can protect sensitive medical information while still allowing justice to be done.

The media, too, carries responsibility. Reporting that names individuals alongside psychiatric diagnoses — especially in small communities — risks creating stigma that endures for generations. Ireland is a compassionate society, but it is also a small one. 

Information travels quickly. Labels stick. Well-intentioned processes in courts, healthcare, and reporting can, if not carefully managed, produce consequences far beyond their original purpose.

Reducing stigma is not only about public campaigns. It is about everyday decisions — in courtrooms, clinics, and newsrooms. It is about recognising that justice should not inadvertently deepen suffering.

If punishment destroys a person’s future long after a sentence ends, it is no longer justice — it is something else entirely.

• Gautam Gulati, University College, Cork and Brendan D Kelly, Trinity College, Dublin