The Irish Penal Reform Trust welcomes findings from a new study carried out by staff of the Central Mental Health hospital. The project was undertaken by Dr. Conor O’ Neill (Consultant Forensic Psychiatrist), Dr Claire McInerney (Senior Register in Psychiatry) and Ms Mary Fitzpatrick (Forensic Community Mental Health Nurse). The initiative funded by the Health Service Executive, the prisons and the courts service was awarded for the Best Hospital Project in the Irish Healthcare Awards 2009. Results indicate that the Prison Inreach and Court Liaison Service based in Cloverhill prison have successfully diverted 91 mentally ill prisoners to community based treatment in 2008.
Mentally-ill offenders are more likely to be incarcerated for minor, non-violent crimes. Findings revealed that the rate of psychosis in Irish sentenced prisons is comparable to other jurisdictions; however there are even higher rates of psychosis in remand settings than other countries. Alarmingly the rate of severe enduring mental illness in Irish remand prisons is almost 10 times the level in the community (Linehan, et al 2005).According to the study a mentally ill offender is more likely to be remanded in custody than a non-mentally ill offender due to homelessness, being unable to provide an address or may not have access to a bail bond. The Prison Inreach and Court Liaison Service were established in Cloverhill as it has the highest remand population in Irish prisons. Inadequate investment in community psychiatric services is highlighted in the report with particular relevance to the lack of service provision for prisoners with dual diagnosis.
The Cloverhill Prison Inreach and Court Liaison Service have the least restrictive environment appropriate mainly for remand prisoners. The Prison Inreach and Court Liaison Service consist of eight people (one consultant, three trainee psychiatrists, three psychiatric nurses and one team administrator). The objectives of the service are to identify prisoners with a severe mental illness in the initial stages. Previous psychiatric contact and a history of psychiatric medication, self-harm and homelessness is assessed. Following this, the identification of appropriate treatment is developed by experts in the area; community based treatment, transfer to the Central Mental Hospital and/or follow-up prison.
The central findings of the study uncover that previous to the introduction of this service, there were far less mentally ill prisoners diverted to community psychiatric treatment. There was an 83% increase in the number of new patient assessments embarked on between 2007 and 2008. 3.1% of remands actively psychotic individuals were identified in 2008 compared with 2.4 in 2007. The time spent in custody for those deemed suitable for local psychiatric services was reduced from 57 days in 2005 to 21 days in 2007.
The diversion of minor offenders with a mental health illness into local community care services allows the capacity of the Central Mental Health hospital to admit high-risk offenders who should not be confined to prison in the first instance.
The IPRT welcomes the recommendations of the study to introduce mental health courts in Ireland which from evidence-based practice highlights the courts success. The study advocates what the IPRT emphasize, people with severe mental illness should be provided with treatment in the least restrictive conditions necessary. The IPRT recommends that imprisonment should not be used to deal with mentally ill offenders.
In a previous IPRT report, Out of Mind, Out of Sight, Solitary Confinement of Mentally Ill Prisoners (2000) (www.iprt.ie), it was found that 78% of those detained in padded cells (solitary confinement) were mentally ill/disturbed. These cells had become a substitute for appropriate medical treatment. The longest number of consecutive days in solitary confinement recorded was 18 days. One prisoner spent 25 days of a 30 day period in a strip cell (solitary confinement).