MHC: Access to Mental Health Services for People in the Criminal Justice System

15th November 2021

A Mental Health Commission (MHC) report exploring Access to Mental Health Services for People in the Criminal Justice System authored by Dr Susan Finnerty, Inspector of Mental Health Services, with special support from the Chief Inspector of Prisons was launched on the 15 November. The report highlights the “gaps in Irish mental health services which lead to mentally ill people ending up in prison,” the conditions for mentally ill people in prison, and the lack of capacity in the Central Mental Hospital (CMH).

Mentally Ill People in Prison

Some clear issues were identified among people with mental disorders in prison – among them significant delays in transfers to psychiatric units, the overuse of restricted regimes, and experiences of bullying. In IPRT’s 2020 Making Rights Real for People with Disabilities in Prison (available here), bullying was also identified as a concern among those with disabilities in prison, and IPRT also recommended an investigation into the possible overuse of restricted regimes among people with disabilities.

Dr Finnerty also visited individual prisons during 2020 and 2021 to see how they accommodate people with mental health issues. Some trends appeared, including limited recreation facilities for those on mental health units, and a lack of any facilities designed for mentally ill patients in 6 prisons. There were long waiting lists for transfer to the CMH from Cloverhill, with some patients were waiting for more than 200 days at the time of inspection. In assessing patients in the Dóchas centre psychiatry caseload, it was found that 67% of patients were actively homeless, 56% suffered from polysubstance abuse, and 41% had some form of childhood trauma.

Diversion to Mental Health Services

In order to divert mentally ill people to mental health services at the trial stage, the report discusses the possibility of establishing a mental health court, which would “strive to reduce the anti-therapeutic effects of the criminal justice system on the mentally ill and enhance any potential therapeutic effects.” It also discusses the work of the Prison Inreach & Court Liaison Service (PICLS), which diverted 1,571 patients from Cloverhill to mental healthcare locations from 2006-2019. While PICLS regularly attends the District Court and provides detailed psychiatric reports at trial, it is not sufficiently resourced to provide input to all District Courts and Garda Stations nationwide. In addition to this, the insufficient capacity of the CMH and other inpatient units, and the complexity of asking for intervention at a later stage through a civil detention process were highlighted as significant challenges to diverting people with mental illness away from the criminal justice system.

The report also highlights the lack of supports available for people with mental disorders who are at risk of offending. In 2020, 616 admission orders ensued from Garda referrals, but it was not clear what happened to the 5,140 other people referred that were not admitted. It was also unclear how much training Gardaí receive to be able to make a judgement call in these referral cases. One positive step, however, is a crisis intervention team proposed for Limerick, which will “hopefully be the first step in pre-arrest diversion across the country.”

Central Mental Hospital

Ireland is noted as having one of the lowest forensic inpatient prevalence rates per 100,000 in Europe, coming 3rd from the bottom in a 2020 study of 16 European countries. The planned move of the CMH to Portrane will also not radically improve this rating, as the report notes that the ratio of beds to people will be 1/3 of the European average after the move.

The report discusses the long stays that some patients are subjected to in the CMH, as it notes that the setting is very restrictive, leading to a “loss of privacy, repetitive daily routines, and low-stimulation environments” for many patients. 54 patients are noted as being in the CMH for more than 5 years, and a lack of community-based supports risk people being kept in forensic institutions for longer than needed. IPRT similarly noted in the 2020 report that long stays in forensic institutions are problematic, particularly since “detention in these settings may last longer than prison without the same due process protections available to prisoners.”

Also of note in the report was that women were only afforded 10 beds in the CMH with no stratification according to need, unlike in the male units. This will be resolved by the move to Portrane, which will increase the number of beds to 20 and provide stratification. The report also showed how many children must be treated in England due to a lack of facilities in Ireland, which is expected to be resolved by the establishment of a 10-bed CAMHS unit in Portrane. There are also only 9 beds for men with an intellectual disability/autism, and none for women. 

Read the full report by the Mental Health Commission here.

IPRT welcomed the report and called for the implementation of all recommendations here.