Why prison is no place for the mentally ill
Medical Lawyer Prison People Cuddigan Instead Are Should In Linehan File Receiving Be There Dan Says Picture: Treatment, Joseph Who
He stares unflinchingly into the screen from the prison he is currently in. His image is beamed into the North Cork courtroom as a judge, gardaí, and a solicitor talk about his case.
His face and eyes are blank of any emotion, even as the judge raises concerns about the length of time he has been in custody for three offences under public order legislation, alleged to have occurred almost two years earlier in a Cork town.
The man, aged in his mid 20s, is pale and gives no flicker of acknowledgement when reference is made to an assault on him in prison in recent times.
Nor is there any sprig of hope to be gleaned from his demeanour when the judge hints that he may strike out the three charges against him, which would pave the way for him to get the help he is believed to need.
No family members are in court to hear the concerns raised, neither are they there two days later when the judge acts on his impulse to strike out the case against him, allowing for him to be taken into custody under Section 12 of the Mental Health Act — a mechanism used to allow a doctor to recommend compulsory admission to hospital for assessment or treatment.
The case came up in court just under a fortnight after the release of the latest batch of prison visiting committee reports, which covered 2022 but which were only published last month.
Several of the reports raised concerns about mentally-ill people being in the prison justice system.
For example, the visiting committee for the Dóchas centre for women in Mountjoy outlined: “As Visiting Committee we reiterate our significant concern and unease about the inappropriate detention of women with serious mental ill-health in the Dóchas Centre and continue to request urgent action in this matter. Our concerns also reflect international best practice.
"The Bangkok rules state that women who are in prison should have gender-specific responses to mental health care and that alternatives to prison should be available for women.”
The reported earlier this month that a third of beds at the 170-bed Central Mental Hospital in Portrane, which opened in November 2022, remain closed because of staffing issues — while 21 people are on the waiting list for a bed at the facility.
Meanwhile, as of August 1, the number of people being treated through the prison psychology service was 526, while approximately 2,090 were waiting to be seen. According to the Irish Prison Service (IPS), the average wait time for a psychology service is 31.4 days.
Criminal lawyer Joseph Cuddigan, who says he has come across numerous cases involving people who should not be in the criminal justice system, believes there are people in a prison setting who should instead be receiving medical treatment. However, there is no other option because of a lack of facilities for such offenders, he contends.
“We have of course the Central Mental Hospital, which has a disproportionate number of beds compared to the general prison population, with the result that there are not beds available for people and then people who should be in a psychiatric setting are not in a psychiatric setting," said Mr Cuddigan.
"They are in a general prison and it is impossible where you have a mixture of inmates, some with psychiatric problems, some who haven’t, and you have the prison officers trying to in effect deal with this blended population.
"Some of them [inmates] are quite conscious of early release and obey the rules and all the rest of it. And then there are other poor people in there who are hearing voices and are in and out of psychotic states and they do not react to the normal inducement of an early release. It is impossible.”
He also said that the pressure of overcrowding in the prison system is an added stressor.
Earlier this year, Mental Health Reform released a report which found that men in prison face significant barriers to accessing mental health care and called for increased funding to support people in prison experiencing mental health difficulties and addiction issues.
Chief executive of Mental Health Reform Fiona Coyle says many people in prison with addiction issues and mental health difficulties are unable to access appropriate treatment.
She welcomes the publication of the Mental Health Bill which was debated in the Dáil last Wednesday, saying it “will help to divert individuals from custody towards supportive environments where they can access in-patient care”.
In its report, Dóchas’ prison visiting committee referenced the High Level Taskforce set up to consider the mental health and addiction challenges of those who come into contact with the criminal justice sector and which published its final report in September 2022. The prison visiting committee hoped it would deliver its recommendations “in a timely fashion”.
Executive director of the Irish Penal Reform Trust Saoirse Brady said that when the taskforce published its report in 2022, “it was published in the same week as Budget 2023 yet its recommendations were not costed”.
“While we have seen some progress, with a number of key initiatives started, many of those short-term recommendations have not yet been completed.”
In its pre-budget submission, the IPRT has identified a number of short-term goals under the taskforce’s radar, including allocating an additional €1.4m to provide ring-fenced funding to the IPS to recruit the minimum number of psychologists required, based on current prison population. It also wants the expansion of the Psychiatric In-Reach and Court Liaison Service model “which between 2006 and 2023 has successfully diverted nearly 2,000 people from prison”.
A spokeswoman for the Department of Health defended the roll-out of the taskforce recommendations, citing achievements including the introduction of the new Mental Health Bill and the replacement of the former Central Mental Hospital in Dundrum with the new hospital in Portrane — which has not been fully opened because of staffing shortages.
It said a focus has been on bringing about “new and real options around diversion", including “more person-centred and integrated care by all relevant health services for this small but highly vulnerable group”.
She also said: “There has been very good co-operation by relevant health and justice agencies to improve interagency planning and delivery of services. These include, for the health sector, progressing initiatives relating to suicide, ADHD, crisis resolution teams, as well as an update of the Mental Health Act 2001.”
A Department of Justice spokesman said progress reports on the implementation of the taskforce’s recommendations will be published annually, including a report in the coming months to cover up to this month.
He cited the expected roll-out of a pilot project in Limerick in the coming months to establish “an appropriate co-response approach to calls relating to mental health and situational trauma”, involving gardaí and the HSE.
The project, which will be a 12-month pilot, was contained in the recommendations of the taskforce but its rollout is two years behind schedule.
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