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Mental health care not fully met in some prisons

A report by the Office of the Inspector of Prisons (OIP) has highlighted that mental health care needs are not being fully or satisfactorily met in any of the seven prisons it inspected, with conditions repeatedly being described as “degrading”.

The inspection was carried out in February and March last year by a team including two international experts in forensic psychiatry.

The provision of care was assessed in seven of the 13 prisons in the State.

Low staffing numbers, inadequate environmental conditions, deficiencies in treatment within prison, and a gross lack of system-wide clinical care pathways are four key issues identified in the report.

The report also said that there appears to be “a long-standing under resourcing of mental healthcare services for prisoners within prison and in HSE civil psychiatric hospital mental healthcare services”.

The report titled ‘OIP Thematic Inspection: An Evaluation of the Provision of Psychiatric Care in the Irish Prison System February – March 2023’, was submitted to the Minister for Justice Helen McEntee in August 2023 and was published today alongside a supporting Irish Prison Service (IPS) Action Plan to implement the recommendations.

In a letter to Minister McEntee in August last year, Chief Inspector of Prisons Mark Kelly said the IPS accepted all of the recommendations that it considers to fall in the scope of its authority, but it cannot accept or implement a number of other recommendations due to their “ownership resting with another body”, namely the Department of Health.

Greater engagement

Mr Kelly said he welcomed the establishment of a Joint Steering Committee between the Department of Justice and the Department of Health but greater engagement between both departments “will be critical if the fundamental problems identified in this report are to be tackled effectively”.

The report found that there are large numbers of prisoners “with serious mental illness, some of whom present significant behavioural and management difficulties”.

It said that prisoner-patients whose condition are so severe as to require transfer to hospital can face long delays.

“Left waiting for very many months on end in dilapidated and sometimes overcrowded prison cells – and on occasion in conditions which could be considered degrading – prior to their transfer.”

Executive Director of the Irish Penal Reform Trust Saoirse Brady, said the report makes for “a sobering read”.

“As mental healthcare in the community fails people who need treatment, what we’re seeing is people with high-level healthcare needs inappropriately being placed in prison as supports and care are not available in the community.”

She said the problem is adding to record levels of overcrowding in prison, but it is also compounding the issues faced by the prison system.

“From overstretched staff, people placed in overcrowded cells in unacceptable conditions, and pressures in accessing support services and healthcare,” she said.

Ms Brady said there is a lack of opportunities to divert those who clearly need care in the community or a hospital away from the criminal justice system.

She said people with low levels of offending are being refused treatment in hospitals which would be a more appropriate response and swift action must be taken to address this.

“However, the Department of Justice cannot address all of these issues alone, the Department of Health has a clear and important role to play in addressing the unacceptable treatment of people with mental health issues who end up in the prison system,” Ms Brady added.

In a statement, the Department of Justice said Minister Helen McEntee welcomed the report.

It said the IPS has engaged constructively with the issues identified in the report and has committed to implement the recommendations under its remit.

“Addressing all of the issues raised in this report requires more than a criminal justice approach.

“This health led approach was basis for the work of the High Level Taskforce (HLTF) established by the Departments of Justice and Health to look at the critical mental health needs of people who engage with the criminal justice system, with a view to ensuring improved outcomes for the individuals concerned and for society as a whole,” the statement said.

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