Róise McGagh shines a spotlight on the issue of mental health within the Irish prison system
Prisons in Ireland abide by the mission ‘Providing safe and secure custody, dignity of care and rehabilitation to prisoners for safer communities’.
Rehabilitation is ‘the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness’.
It was recently highlighted in Northern Ireland that the lives of prisoners in Northern Ireland were at risk after they left custody. There were 23 deaths in custody and the same amount within two weeks of release between 2014 and 2019.
Within the last six years, the same time period, 60 people have died while in the custody of the Irish Prison Service (IPS) – a similar percentage of the prison population.
Between 2014 and 2017 around eight people passed away within a month of being released from prison, with the rest of the figures yet to be released. The coroner reports are not yet available for all of 2018 and 2019, however it can be inferred from 2014 to 2017 of the 36 people that died in custody, around 17 of them were subject to poor mental health or suicidal thoughts.
Self-harm
The Irish Penal Reform Trust (IPRT) has been campaigning, particularly over the last two years, for improved access to mental health facilities. In January 2020 they released a guide, Women in Prison: Mental health and well-being in response to the high levels of poor mental health among women in prison. Rates of self-harm range from 7% to 15% for males and up to 27% for females.
People in prison have been shown to have a disproportionately high rate of poor mental health and research suggests that around one in seven prisoners have a serious mental health problem.
Often people with chronic mental health issues end up in the prison system due to a lack of access to mental health services in the community. The mental health services in Ireland have been criticised for not providing adequate care for people who need help, especially those who are suicidal.
Several reports found that the Health Service Executives (HSE) movement on implementation on the 2006 strategy for mental health services in Ireland ‘A Vision for Change’ was “slow and inconsistent”. The lack of mental health services available is made up for my voluntary groups such as Pieta House, Samaritans and Aware, to name but a few.
They recommend additional intensive care rehabilitation units for those recovering from mental illness which has not yet been implemented after 14 years.
The IPRT included establishing a cross-departmental task force on mental health and imprisonment as one of their five recommendations for the incoming 2020 government that would allow them to “invest in health and housing, not prison spaces”. Their Progress in the Penal System (PIPS) 2019 report found that there are “approximately 300 people with severe mental illness in Irish prisons, with an average 20-30 people awaiting transfer to receive treatment in the Central Mental Hospital at any given time”.
In an interview with The Irish Catholic, Michelle Martyn, the Senior Research and Policy Project Manager with the IPRT said:“The access to psychology services (in Irish prisons) is quite limited, there’s a waiting list of 614 people. In terms of addiction counselling there is, the latest figures say about 314 are waiting for treatment from counselling services in prisons. There is one addiction counsellor for 300 people in Cloverhill Prison so services are quite restricted for access.
“There’s 19.8 full-time addiction counsellors across the state and so the ratio example of Cloverhill is probably the worst, 1 to 431,” Ms Martyn said.
Report
Last year a report from the Irish Times revealed that the chaplaincy in Cloverhill told the Minister of State at the Department of Health Jim Daly: “The State is failing people who are mentally ill by knowingly relying on the existence of Cloverhill Prison to incarcerate them, rather than addressing their particular needs in other, more appropriate ways.”
In the same report, the chaplaincy at Wheatfield Prison highlighted the use of long-term isolation for prisoners who caused trouble. The length of time spent in isolation in Irish prisons is not published.
“We don’t know the length of time people are spending in safety observation cells, if someone is a risk to themselves, they may be placed in a safety observation cells. We don’t know the time that someone could be there, we don’t know the length of time someone could be in solitary confinement,” says Ms Martyn. “You don’t know if it’s 10 days or 200 days.”
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Safety observation cells are designed to accommodate prisoners who require frequent observation for medical reasons or because they were a danger to themselves. They are meant to be checked at least every 15 minutes. In many of the Deaths in Custody reports it was shown that these cells were often not supervised in accordance with this rule, with sometimes over an hour between checks.
After an inquest with a verdict of suicide in 2019 which investigated the death man who passed away four hours after he had been committed to Cork Prison the IPS was urged to keep its nursing committal forms under review. The 15-minute checks were not being carried out. Following this the IPS created a new policy where ordinary observations changed to every three hours so resources could be directed to those on special observations or those ‘at risk’.
As of January 2020, five prisoners were accommodated in Safety Observation Cells and 8 prisoners were accommodated in Close Supervision Cells (to accommodate prisoners who were a danger to others in the prison or who were disruptive in the opinion of management). Census figures also show that 75 people were being held in solitary confinement in January 2020, on 22- and 23-hour restricted regimes.
The Self-harm in Irish Prisons 2017 report the number of incidents of self-harm among the general prison population and the number of people that are on restrictive regimes. Over the year there were 223 episodes of self-harm recorded involving 138 prisoners.
The average age was 32 and 80% of the cases were males. Three-quarters of the incidents involved someone in single cell accommodation – over half the prison population were accommodated in single cells in 2017 and still are as of January 2020. Of those who engaged in self harm, 44% were in protection and the remaining 44% were in general population accommodation.
Approximately one in six of these incidents were deemed to have a high degree of suicidal intent.
“Once someone comes into prison their mental health needs will be assessed and they might be diverted into a potential mental hospital,” says Ms Martyn. However, the Central Mental Hospital (CMH) in June 2019 was operating at 100% of its capacity, with admissions “systematically triaged according to the level of therapeutic security required and the urgency of clinical need”. If a person is not immediately diverted into mental health services, the average wait time for a transfer from prison to the CMH is 120.86 days – a range of between seven and 504 days.
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This year the CMH is due to be relocated to a new forensic mental health facility in Portrane. It will still only have a maximum capacity of 170 patients which according to the IPRT “will not meet demand based on the current and persistent number of prisoners awaiting transfer”.
“Suicide comes up a lot in some of the death in custody reports by the inspector of prisons. Particularly for those on remand, they usually have higher health needs,” said Ms Martyn.
Some problems such as giving prisoners access to sports have been solved before by community projects”
There are many factors that would be detrimental to someone’s mental health in the prison environment, overcrowding, sharing a cell or the often-restricted regimes said Michelle, “all of that would exacerbate any mental health issues”.
“It’s been an issue for a number of years but having access to education being able to go to the gym being able to go to workshops it’s all very important for anybody’s mental health.”
A government report by the Inter-Agency Group for a Fairer and Safer Ireland 2018, reported concerns about the impact of the current housing crisis on people coming out of prison alongside access to mental health programmes and drug treatment programmes, income support on release, work activation programmes and other issues.
In recent years the number of people who enter into Irish prisons who declared they had no fixed abode has steadily increased. In 2014 there were 265 prisoners with no fixed abode and in 2018 it almost doubled to 502. Some of these figures account for people who have lost their rented private accommodation due to their committal to prison.
In 2018, the IPS Resettlement Service helped 414 prisoners make an application for social housing and worked alongside local authorities to provide details of housing requirements before their release. Up until the end of October 2019 the Resettlement Service had submitted 303 applications for social housing.
“Around 70% of prisoners have addiction issues. And obviously addiction is often a symptom of social exclusion and these issues could be addressed prior to prison,” says Ms Martyn. This is around 85% for women.
She said that there is little in the way of support after a person leaves prison: “In terms of support upon release there’s organisations like PACE who would support people in terms of housing but in terms of counselling I don’t think there’s anything specifically for people coming out of prison, so there could be a lot more continuity of care. Even preparation prior to release and awareness of services.”
Counselling
In terms of counselling and addiction services there could be involvement from the communities in which the prisons are situated. Some problems such as giving prisoners access to sports have been solved before by community projects. “I think that there needs to be some kind of change in attitude, a change in public opinion. And I suppose that’s about public education but also there are some very good community projects going on where the community is involved for example the bohemian foundation go into Mountjoy Prison and they’d be involved in sports and different programs like that,” said Ms Martyn.
There has been little research in recent years in terms of the characteristics of people who go to prison. However, previously research would have highlighted the link between crime and economic deprivation and people coming from particular communities; the link between crime and social exclusion.
The EU Commission for the Prevention of Torture (CPT) in their 2015 report on Ireland highlighted the large amount of people with mental illness in the IPS that shouldn’t be there. The CPT visited Ireland again in 2019 and their findings will be released at some point this year.
The UN Committee Against Torture (CAT) highlighted the need to employ additional personnel in terms of psychology and counselling services within Irish Prisons in 2017.
If more people were diverted from the prison system and toward the mental health services they needed it would also reduce the frequency with which Irish prisons are overcrowded”
There was also a review done on the psychology services which was commissioned by the IPS in 2015 which showed the Irish standard ratio of psychology services was one psychologist per 220 prisoners in comparison to the international standard ratio of around one for every 150 or 160.
“We would be Advocating in terms of having a high level task voice between different agencies like the Department of Health, the Irish Prison Service the Department of Justice and Equality and other stakeholders,” said Ms Martyn in response to how this mental health crisis within the prisons system could possibly be managed.
If more people were diverted from the prison system and toward the mental health services they needed it would also reduce the frequency with which Irish prisons are overcrowded. Overcrowding has been a prevalent issue in many prisons in 2020 already, in particular the women’s prisons, Dóchas, Limerick female prison as well as Limerick male prison, Castlerea and Arbour Hill prisons. Limerick male is currently at 101% capacity with the rest listed between 82% and 97% capacity.
“It’s [mental health] probably one of the biggest issues in the prison system,” said Michelle.
In order to for the IPS to be a system of rehabilitation there would have to be provisions for restoring prisoners to health, particularly to their full mental health through training and therapy after imprisonment.